不同剂量雌激素在重度宫腔粘连术后预防再粘连的临床疗效观察

发布时间：2017-12-27 06:22

本文关键词：不同剂量雌激素在重度宫腔粘连术后预防再粘连的临床疗效观察　出处：《中国计划生育和妇产科》2016年02期 　论文类型：期刊论文

【摘要】：目的探讨重度宫腔粘连(intrauterine adhesion,IUA)在宫腔镜下粘连分离术后注水球囊、宫内节育器(Intrauterine Device,IUD)联合不同剂量雌激素预防再粘连的临床效果。方法选取2008年1月至2013年1月在遵化市人民医院宫腔镜检查确诊为重度IUA行腹腔镜监视下宫腔镜下IUA分离术后开注水球囊、放置"O"型IUD 1枚的60例患者,根据术后应用雌激素方法不同分为研究组及对照组:研究组30例,术后第1 d连续服用戊酸雌二醇3 mg,3次/d,3个月,后10 d加黄体酮胶囊200 mg,1次/d,10 d后撤退出血;对照组30例,术后第1 d服用戊酸雌二醇2 mg,3次/d,21 d,后10 d加黄体酮胶囊200 mg,1次/d,10 d后撤退出血,3个周期。术后3个月复查IUA情况及宫腔镜检查、取IUD,轻度膜状粘连者以检查镜予分开。术后3月观察月经情况。分别在用药前及用药后3个月抽取患者清晨空腹血样,检测凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)及纤维蛋白原(fibrinogen,Fib)、丙氨酸转氨酶(Alanine transaminase,ALT)、谷草转氨酶(Aspertate transferase,AST)、甘油三脂(triglyceride,TG)及总胆固醇(total cholesterol,TC)指标。结果研究组宫腔镜手术后宫腔再粘连3例(10%);对照组宫腔再粘连5例(16.67%),两组比较差异无统计学意义(P0.05)。月经改善研究组29例(96.67%);对照组22例(73.3%),差异有统计学意义(P0.05)。治疗前及治疗后3月两组患者PT、APTT、TT、Fib、ALT、AST、TG及TC指标比较差异均无统计学意义(P0.05)。结论重度IUA术后注水球囊、IUD联合大剂量雌激素(3 mg)连续口服能明显改善月经情况,无术后并发症,安全、有效。
[Abstract]:Objective to investigate the clinical effect of intrauterine adhesion (IUA) combined with Intrauterine Device (IUD) combined with different doses of estrogen to prevent re adhesion after hysteroscopic adhesion separation. Methods 60 cases from January 2008 to January 2013 for severe IUA underwent laparoscopic dissection under hysteroscopic IUA monitoring in hysteroscopy diagnosis of Zunhua City People's hospital after open water balloon, placing "O" IUD 1 patients, according to the application of estrogen after surgery were divided into study group and control group: the study group of 30 cases, surgery first d after continuous administration of estradiol valerate 3 mg, 3 /d, 3 months after the 10 D plus progesterone capsules 200 mg, 1 /d, 10 d after withdrawal bleeding; 30 cases in the control group, after first D with estradiol valerate 2 mg, 3 /d, 21 d, 10 D plus progesterone capsules 200 mg, 1 /d, 10 d after withdrawal bleeding, 3 cycles. The IUA situation and the hysteroscopy and IUD were reviewed 3 months after the operation. The patients with mild membranous adhesions were separated by the examination mirror. The period of menstruation was observed in March. Respectively before and after treatment for 3 months were collected fasting blood samples, prothrombin time (prothrombin time, PT), activated partial thromboplastin time (activated partial thromboplastin time, APTT), thrombin time (thrombin time, TT) and fibrinogen (fibrinogen, Fib), alanine aminotransferase (Alanine, transaminase, ALT) aspartate aminotransferase (Aspertate, transferase, AST), glycerin three greases (triglyceride, TG) and total cholesterol (total, cholesterol, TC index). Results in the study group, there were 3 cases of uterine cavity readhesion after hysteroscopic surgery (10%), and 5 cases (16.67%) of uterine cavity readhesion in the control group (16.67%), there was no significant difference between the two groups (P0.05). The study group of menstruation improved 29 cases (96.67%), and 22 cases (73.3%) in the control group, the difference was statistically significant (P0.05). There was no significant difference in the indexes of PT, APTT, TT, Fib, ALT, AST, TG and TC between the two groups before and after the treatment (P0.05) before and after the treatment in March. Conclusion the continuous oral injection of water injection, IUD combined with large dose of estrogen (3 mg) after severe IUA can obviously improve the menstrual condition without postoperative complications, which is safe and effective.
【作者单位】：遵化市人民医院妇科;
【分类号】：R713.4
【正文快照】： 宫腔粘连(intrauterine adhesion,IUA)是由于各种原因导致子宫内膜基底层损伤引起子宫肌壁的相互粘连、部分或全部宫腔粘连在一起,临床主要表现为月经改变、腹痛、妊娠异常等,是继发不孕的首要宫腔病因[1]。近年来有逐渐增多的趋势。宫、腹腔镜联合治疗重度IUA可直视下进行粘

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