左炔诺孕酮宫内缓释系统联合醋酸亮丙瑞林治疗子宫腺肌病的研究进展

Research Progress on the Levonorgestrel-Releasing Instrauterine System Combined with Leuprorelin Acetate in the Treatment of Adenomyosis

摘要: 子宫腺肌病(adenomyosis, AM)近年来逐渐成为女性盆腔疼痛常见的病因之一，严重影响其日常生活及工作，加重女性的心理负担，因此AM的治疗方案亟需被优化。AM现有的治疗手段包括手术治疗及保守治疗，由于近年来发病年龄趋于年轻化，手术治疗会对年轻患者生育能力造成影响，因此对于有生育要求的年轻患者，保守治疗的选择至关重要。其中左炔诺孕酮宫内缓释系统(Levonorgestrel-releasing intrauterine system，LNG-IUS，曼月乐)因其持续高效的局部作用，可预防内膜病变，同时兼具避孕效果等多种优势，现已经被临床广泛应用，但因其具有易脱落、淋漓出血等不良反应，故采用联合方案可协助提升治疗效果。注射用醋酸亮丙瑞林微球(Leuprorelin Acetate Microspheres for Injection)联合ING-IUS现已成为临床常用的联合方案，本文系统综述了该联合方案治疗AM的研究进展，旨在阐明该方案的综合优势，为临床治疗提供参考依据。

Abstract: Adenomyosis (AM) has increasingly become one of the common etiologies of chronic pelvic pain in women, significantly compromising their daily activities and occupational functioning while exacerbating psychological burden. Therefore, optimization of therapeutic strategies for AM is urgently needed. Current treatment modalities for AM encompass surgical intervention and conservative management. Given the trend toward younger age at onset in recent years, surgical treatment may adversely affect fertility in young patients; thus, conservative management is of critical importance for young patients with reproductive desires. Among conservative options, the Levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) has been widely adopted in clinical practice due to its sustained and potent local effects, capacity for endometrial protection, and concurrent contraceptive benefits. However, adverse events such as device expulsion and irregular spotting or prolonged bleeding necessitate the use of combination regimens to enhance therapeutic efficacy. The combination of Leuprorelin acetate microspheres for injection with LNG-IUS has emerged as a commonly employed clinical regimen. This article systematically reviews the research progress on this combination therapy in the treatment of AM, aiming to elucidate its comprehensive advantages and provide evidence-based reference for clinical practice.