LNG-IUS固定术治疗子宫腺肌病期间发生大出血致重度贫血一例

doi:10.12280/gjfckx.20250063

摘要/Abstract

摘要：

左炔诺孕酮宫内缓释节育系统（levonorgestrel-releasing intrauterine system，LNG-IUS）是治疗子宫腺肌病的有效方法，但脱落率较高。宫腔镜缝合固定术是一种新兴微创技术，可改善LNG-IUS的稳定性。报告1例37岁子宫腺肌病患者，因LNG-IUS脱落史接受LNG-IUS固定术，术后短期疗效显著，但术后11个月发生持续性大量阴道出血，最终行腹腔镜下暂时阻断子宫动脉挖除子宫腺肌病手术治疗。该病例提示LNG-IUS固定术具有良好的短期疗效，但需警惕其长期并发症，术前应充分评估患者病情，术后加强随访管理，以减少严重不良事件的发生。

关键词: 子宫腺肌病, 宫腔镜检查, 左炔诺孕酮, 子宫出血, 治疗

Abstract:

The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective method for treating adenomyosis, but it has a relatively high expulsion rate. Hysteroscopic suture fixation is a new minimally invasive technique that can improve the stability of LNG-IUS. This paper reports a case of a 37-year-old patient with adenomyosis. The patient received LNG-IUS fixation due to a history of LNG-IUS expulsion. The short- term efficacy after the operation was remarkable. However, persistent and massive vaginal bleeding occurred 11 months after the operation. Eventually, laparoscopic surgery to temporarily block the uterine artery and remove the adenomyosis lesions was performed. This case suggests that LNG-IUS fixation has good short-term efficacy, but long-term complications should be vigilant. The patient′s condition should be fully evaluated before surgery, and follow-up management should be strengthened after surgery to reduce the occurrence of severe adverse events.

Key words: Adenomyosis, Hysteroscopy, Levonorgestrel, Uterine hemorrhage, Therapy

李飞艳, 朱从心, 李咏, 孙丽, 刘瑜. LNG-IUS固定术治疗子宫腺肌病期间发生大出血致重度贫血一例[J]. 国际妇产科学杂志, 2025, 52(3): 271-274.

LI Fei-yan, ZHU Cong-xin, LI Yong, SUN Li, LIU Yu. A Case of Severe Anemia Caused by Massive Hemorrhage during the Treatment of Adenomyosis with LNG-IUS Fixation[J]. Journal of International Obstetrics and Gynecology, 2025, 52(3): 271-274.

图/表 4

图1 宫腔镜所见注：宫腔血管明显增生、裸露，宫腔形态不规则。

图2 腹腔镜下子宫大体图注：腹腔镜下见子宫弥漫性球形增大。

图3 子宫腺肌病病灶组织病理图（HE染色×200）注：平滑组织中间个别子宫内膜腺体浸润，右下角伴子宫内膜间质分布。标尺=100 μm。

图4 患者的临床病程注：GnRH-a 促性腺激素释放激素激动剂，CA125 糖类抗原125。子宫大小定义为子宫长度（mm）×厚度（mm）×宽度（mm）。

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