探讨热球子宫内膜去除术联合曼月乐治疗围绝经期排卵障碍性异常子宫出血的临床疗效，为异常子宫出血的患者提供更好的治疗方式。

选取2018年7月至2020年10月期间北京大学首钢医院收治的异常子宫出血患者102例纳入研究，依据治疗方式的不同分为3组，曼月乐组（55例）采用宫腔内放置曼月乐（左炔诺孕酮宫内缓释系统）治疗；热球组（21例）采用热球子宫内膜去除术治疗；热球+曼月乐组（26例）采用热球子宫内膜去除术，术中同时宫腔内放置曼月乐治疗，术后随访6个月以及1年，比较3组患者的临床疗效以及治疗前后月经量减少情况、内膜厚度、血红蛋白的变化。

曼月乐组治疗后6个月及1年总有效率分别为70.90%，76.36%，热球组治疗后6个月及1年总有效率分别为71.43%，80.95%，曼月乐组与热球组患者治疗后6个月总有效率比较差异无统计学意义（P＞0.05），2组治疗后1年的总有效率比较差异有统计学意义（P＜0.05），热球+曼月乐组治疗后6个月、1年的总有效率分别为96.15%、100%，均高于曼月乐组和热球组，差异均有统计学意义（P＜0.01）。3组患者治疗前月经量评分、子宫内膜厚度、血红蛋白水平对比差异均无统计学意义（P＞0.05），治疗后3组患者6个月，1年月经量评分均明显低于治疗前，差异均有统计学意义（P＜0.05），且曼月乐+热球组均低于曼月乐组及热球组，差异均有统计学意义（P＜0.05），治疗后3组患者6个月，1年子宫内膜厚度均明显低于治疗前，差异均有统计学意义（P＜0.05），且曼月乐+热球组治疗后6月及1年子宫内膜厚度均明显低于曼月乐组及热球组，差异均有统计学意义（P＜0.01）；治疗后3组患者6个月，1年血红蛋白含量均明显高于治疗前，差异均有统计学意义（P＜0.05），且热球+曼月乐组治疗后6个月，1年血红蛋白含量均明显高于其他2组，差异均有统计学意义（P＜0.01）。随访6个月发现曼月乐组，曼月乐环脱落者3例，随访6个月及1年发现热球子宫内膜去除术联合曼月乐组无曼月乐环脱落患者；本研究在后续长期随访中发现曼月乐组因治疗效果欠佳，反复出血，行子宫切除术者2例，另有1例改用热球子宫内膜去除术治疗，热球组因反复出血行子宫切除者1例，而联合组随访至今未见因效果欠佳而行子宫切除术，或者改用其他治疗方法者，但因样本量有限，仍需进一步研究证实。

热球子宫内膜去除术联合曼月乐治疗异常子宫出血均疗效显著，热球子宫内膜去除术与曼月乐联合治疗异常子宫出血在减少月经量、改善患者贫血等方面更有优势，从治疗效果方面评估可为异常子宫出血患者提供更好的治疗选择。

To evaluate the clinical efficacy of thermal balloon endometrial ablation (TBA) combined with the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) in the treatment of perimenopausal dysfunctional uterine bleeding, so as to provide a better treatment for patients with abnormal uterine bleeding.

One hundred and two patients with abnormal uterine bleeding who were treated at Shougang Hospital of Peking University from July 2018 to October 2020 were selected and divided into three groups according to different treatment methods used: LNG-IUS group, TBA group, and combination therapy group. The LNG-IUS group (55 cases) was treated with LNG-IUS, the TBA group (21 cases) was treated with TBA, and the combination therapy group (26 cases) was treated with LNG-IUS and TBA. The patients were followed at 6 months and 1 year after the surgery. The clinical efficacy, the reduction of menstrual quantity assessed with pictorial blood loss assessment chart, endometrium thickness, and hemoglobin level after treatment were compared among the three groups.

The total effective rates at 6 months and 1 year after treatment were 70.90% and 76.36% in the LNG-IUS group, 71.43% and 80.95% in the TBA group, and 96.15% and 100% in the combination therapy group, respectively. There was no significant difference between the LNG-IUS and TBA groups at 6 months after treatment (P＞0.05), though there was significant difference between the two groups at 1 year (P＜0.05); the total effective rates at 6 months and 1 year in the combination therapy group were higher than those in the other two groups (P＜0.01). There was no significant difference in menstrual volume score, endometrial thickness, or hemoglobin level among the three groups before treatment (P＞0.05). The menstrual volume scores at 6 months and 1 year were significantly lower than those before treatment in all the three groups (P＜0.05), and they were lower in the combination therapy group than in the other two groups (P＜0.05). The endometrial thickness at 6 months and 1 year was significantly lower than that before treatment in all the three groups (P＜0.05), and the endometrial thickness at 6 months and 1 year was significantly lower in the combination therapy group than in the other two groups (P＜0.01). The hemoglobin levels at 6 months and 1 year were significantly higher than those before treatment in all the three groups (P＜0.05), and the hemoglobin levels at 6 months and 1 year were significantly higher than those of the other two groups (P＜0.01). At the 6-month follow-up, three cases of expulsion of IUD occurred in the LNG-IUS group, but no expulsion of IUD occurred in the combination therapy at both the 6-month and 1-year follow-up. After long-term follow-up, it was found that in the LNG-IUS group, hysterectomy was performed in two cases due to poor treatment effect and repeated bleeding, and another case was treated with TBA. In the TBA group, hysterectomy was performed in one case due to repeated bleeding. However, in combined therapy group, no hysterectomy or other treatment was performed due to poor results.

LNG-IUS, TBA, and their combination are all effective in the treatment of abnormal uterine bleeding. The combination of TBA and LNG-IUS has more advantages in reducing menstrual quantity and improving anemia, representing a better treatment choice for patients with abnormal uterine bleeding.