目的：总结左炔诺孕酮宫内缓释系统（LNG-IUS）治疗子宫腺肌病（AM）的证据，并找出潜在的研究空白。
方法：在MEDLINE中进行搜索，科克伦图书馆,EMBASE,CBM,CNKI,还有万方。我们纳入了调查接受LNG-IUS联合保守治疗的AM患者的研究。
结果：39项研究比较了LNG-IUS与其他保守治疗药物。最常见的比较是GnRH-a+LNG-IUS与仅液化天然气-IUS，其次是LNG-IUSvs.米非司酮,预期治疗,和GnRH-a.在6个月的随访中，GnRH-aLNG-IUS比单独使用LNG-IUS更有利于减轻子宫增大和中度至重度痛经的患者的痛经强度。需要大型且精心设计的研究来确认LNG-IUS和GnRH-a在6个月随访时减少子宫体积的功效。32项研究调查了LNG-IUS作为术后管理。最常见的比较是手术切除+LNG-IUS与手术切除。结果显示，在1年随访时，手术切除+LNG-IUS组的VAS评分低于手术切除组。子宫内膜厚度的证据,生活质量,需要3年和5年的不良事件和有益效果。
结论：对于子宫增大和中度至重度痛经的患者，GnRH-a和LNG-IUS联合治疗比单独使用LNG-IUS更有效。此外，LNG-IUS似乎在术后治疗中显示出潜在的长期益处，需要进一步的荟萃分析以进行确认。
OBJECTIVE: To summarize evidence on levonorgestrel releasing intrauterine system (LNG-IUS) in the treatment of adenomyosis (AM) and to identify potential research gaps.
METHODS: Search was conducted in MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI, and Wanfang. We included studies investigating patients with AM treated with LNG-IUS combined with conservative therapy.
RESULTS: Thirty-nine studies compared LNG-IUS with other conservative therapeutic drugs. The most common comparison was GnRH-a + LNG-IUS vs. LNG-IUS alone, followed by LNG-IUS vs. mifepristone, expected treatment, and GnRH-a. GnRH-a + LNG-IUS was more beneficial in reducing the intensity of dysmenorrhea than LNG-IUS alone at the 6-month follow-up in patients with an enlarged uterus and moderate to severe dysmenorrhea. Large and well-designed studies are needed to confirm the efficacy of LNG-IUS and GnRH-a on reducing uterine volume at 6-month follow-up. Thirty-two studies investigated LNG-IUS as the postoperative management. The most common comparison was surgical excision + LNG-IUS vs. surgical excision. Results showed VAS scores were lower in the surgical excision + LNG-IUS group than in the surgical excision group at the 1-year follow-up. Evidence on endometrial thickness, quality of life, adverse events and beneficial effect at 3 and 5 years are needed.
CONCLUSIONS: Combined GnRH-a and LNG-IUS treatment was more efficacious than LNG-IUS alone for patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, LNG-IUS seemed to show potential long-term benefits in postoperative therapy, warranting further meta-analysis for confirmation.
