子宮內膜異位術後裝設Lng-IUD可減少復發問題(轉載自國際後生健康園區)
http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=2621&x_classno=0
作者：Mindy Hung, Medical Writer
出處：WebMD醫學新聞
審閱：Brunilda Nazario, MD
Aug. 29, 2003--根據一篇發表於8月號Fertility and Sterility的公開標示、隨機化的控制組研究結果顯示，在出現症狀的子宮內膜異位手術之後，插入左炔諾孕酮（LNG）子宮內釋放系統levonorgestrel，可以減少中至重度的月經困難復發。
義大利Istituto大學的Paolo Vercellini博士表示，內視鏡手術經常是選擇出現症狀的疾病進行治療，但是結果不一定令人滿意，疼痛復發也是常見的。
研究人員招收77名40歲的女性，她們正在進行第一線的內視鏡手術以治療出現症狀的第IV階段子宮內膜異位，她們都不想要有孩子，並且報告月經困難問題已經有六個月以上，20名受試者分配至插入Lng-子宮內避孕器組，其他只進行傳統手術。
在手術後一年，患者被要求完成一份修改過的Biberoglu 和 Berhman 的評級表，以評估月經困難、嚴重消化不良和非月經的陰部疼痛發生率及嚴重性，以反應功能上的障礙，並且利用一個100毫米的視覺模擬量表，估測受試者對於症狀的感知度，女性也針對她們收到的治療進行滿意度的評級。
插入Lng-子宮內避孕器組的患者中，有2名復發中度或重度月經困難(10%)，傳統手術組有9位(45%)，插入Lng-子宮內避孕器組的患者相對於傳統治療組的月經困難復發風險比例為35%（95% 信賴區間 [ CI ]， 9%-61%）。
這平均每三個插入Lng-子宮內避孕器的患者中，在手術後1年內，就有一人阻止中度或重度的月經困難復發（CI 95% ， 2-11）其相對風險降低了78%。
在Lng-宮內避孕器組中的15名患者(75%)，及傳統手術組中的10名患者的(50%) 對於收到的治療感到滿意，在子宮內膜異位的傳統手術之後，插入含藥的裝置，可以減少月經困難復發的危險，而且是有效、安全和方便的輔助治療，還需要進一步的研究以証實是否在5年之中具有良好的觀察結果。
Lng-IUD After Surgery for Symptomatic Endometriosis Reduces Recurrence of Dysmenorrhea
By Mindy Hung, Medical Writer
Medscape Medical News
Aug. 29, 2003 — Insertion of a levonorgestrel-releasing intrauterine device (Lng-IUD) after laparoscopic surgery for symptomatic endometriosis reduces the medium-term risk of recurrence of moderate or severe dysmenorrhea, according to results of an open-label, randomized controlled pilot study published in the August issue of Fertility and Sterility.
"Laparoscopic surgery is often the treatment of choice for symptomatic disease, but results are not always satisfactory and pain recurrence is common," write Paolo Vercellini, MD, and colleagues, from the Istituto "Luigi Mangiagalli" at the University of Milano, Italy.
Investigators enrolled 40 of 77 parous women aged 40 years or younger who were undergoing first-line operative laparoscopy for symptomatic stage I-IV endometriosis, did not want children, and had reported disabling dysmenorrhea of more than six months' duration. Twenty subjects were allocated to Lng-IUD insertion after laparoscopic treatment, and 20 to conservative surgery only.
One year after surgery, patients were asked to complete questionnaires that graded presence and severity of dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain on a modified Biberoglu and Berhman rating scale, which reflected functional impairment, and on a 100-mm visual analog scale that estimated subjective perception of symptoms. The women also rated their overall degree of satisfaction with the treatment.
Moderate or severe dysmenorrhea recurred in 2 (10%) of 20 patients in the postoperative Lng-IUD group and in 9 (45%) of 20 in the surgery-only group. The absolute risk reduction of dysmenorrhea recurrence in subjects undergoing Lng-IUD insertion compared with those allocated to expectant management was 35% (95% confidence interval [CI], 9% - 61%).
"This means that an Lng-IUD inserted postoperatively will prevent the recurrence of moderate or severe dysmenorrhea in one out of three patients (95% CI, 2-11) 1 year after surgery, with a relative risk reduction of 78%," investigators write.
Fifteen (75%) of 20 patients in the Lng-IUD group and 10 (50%) of 20 patients in the expectant management group were satisfied or very satisfied with the treatment received.
"Insertion of a medicated device after conservative surgery for endometriosis may constitute an innovative, effective, safe, and convenient adjuvant treatment for the long-term reduction of risk of dysmenorrhea recurrence," they conclude. "Further trials are needed to verify whether the good results observed are maintained during the entire 5-year period of efficacy of the system."
Fertil Steril. 2003;80:305-309
Reviewed by Brunilda Nazario, MD
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