不同剂量雌激素对重度宫腔黏连术后复发及月经的影响

发布时间：2018-03-10 12:28

  本文选题：雌激素　切入点：剂量　出处：《中华妇幼临床医学杂志(电子版)》2016年05期 　论文类型：期刊论文

【摘要】：目的探讨重度宫腔黏连(SIUA)患者宫腔镜下经宫颈宫腔黏连分离术(TCRA)后,应用不同剂量雌激素对黏连复发和月经的影响。方法选择2010年1月至2015年6月,于南京医科大学第一附属医院接受宫腔镜下TCRA的275例SIUA患者为研究对象。根据TCRA后雌激素治疗剂量,将其分为低剂量组(n=89)、中剂量组(n=82)、高剂量组(n=73)及对照组(n=31)。低、中、高剂量组TCRA后分别给予戊酸雌二醇3、6、9mg/d×21d联合醋酸甲羟孕酮10mg/d×5d治疗,对照组TCRA后未给予任何雌激素治疗。统计学分析4组患者年龄、孕次、产次、既往宫腔手术史、子宫内膜厚度、宫腔深度,治疗前、后美国生育协会(AFS)评分及月经情况,治疗后妊娠、不良反应情况及治疗疗效。结果 14组患者年龄、孕次、产次、既往宫腔手术史,以及TCRA前继发性闭经、月经量减少、继发不孕、复发性或稽留流产、周期性下腹痛、子宫内膜厚度及宫腔深度等一般临床资料比较,差异均无统计学意义(P0.05)。2不同剂量雌激素治疗前、后,4组AFS评分下降值比较,差异有统计学意义(F=43.750,P=0.000);而低、中、高剂量组均较对照组显著增高,并且差异均有统计学意义(t=7.011、7.199、6.292,均为P=0.000)。低、中、高剂量组患者治疗前、后AFS评分下降值两两比较,治疗后4组患者月经恢复正常和月经量增多比例分别比较,以及治疗后低、中、高剂量组患者闭经或月经量过少比例两两比较,差异均无统计学意义(P0.05)。治疗后4组患者闭经或月经量过少比例比较,差异有统计学意义(χ~2=39.490,P=0.000)。低、中、高剂量组患者闭经或月经量过少比例,均较对照组低,并且差异均有统计学意义(χ~2=14.623、27.265、21.105,均为P=0.000)。34组不良反应率比较,差异有统计学意义(χ~2=37.182,P=0.000)。低、中、高剂量组不良反应率均较对照组高,高剂量组不良反应率高于低、中剂量组,并且差异均有统计学意义(P0.05);低、中剂量组不良反应率比较,以及4组患者因不良反应导致停药率比较,差异均无统计学意义(P0.05)。44组患者治疗总有效率比较,差异有统计学意义(χ~2=39.490,P=0.000)。其中,低、中、高剂量组患者治疗总有效率,均较对照组高,差异均有统计学意义(P0.05);低、中、高剂量组患者治疗总有效率分别两两比较,以及4组患者妊娠率比较,差异均无统计学意义(P0.05)。结论 SIUA患者TCRA后,应用雌激素治疗,可有效减少SIUA复发,改善患者月经状况。不同剂量雌激素治疗SIUA患者,疗效无明显差异。
[Abstract]:Objective to investigate the effects of different doses of estrogen on relapse and menstruation of severe intrauterine adhesion syndrome (SIUAA) patients after hysteroscopic hysteroscopy. Two hundred and five patients with TCRA received hysteroscopy in the first affiliated Hospital of Nanjing Medical University were studied. According to the dose of estrogen after TCRA, they were divided into three groups: low dose group, middle dose group, high dose group and control group. The high dose group was treated with estradiol valerate (Estradiol valerate) 6 mg / d 脳 21 d and medroxyprogesterone acetate 10 mg / d 脳 5 d after TCRA, while the control group was not treated with any estrogen after TCRA. Results the age, pregnancy, labor, history of intrauterine surgery, and secondary amenorrhea before and after treatment, and secondary amenorrhea before and after TCRA, were evaluated in 14 groups, including the depth of uterine cavity, the score of AFS before and after treatment, the status of pregnancy, adverse reactions and therapeutic effects. There was no significant difference in menstrual volume, secondary infertility, recurrent or missed abortion, periodic lower abdominal pain, endometrial thickness and uterine cavity depth before treatment with different doses of estrogen. The decrease of AFS score in the 4 groups was significantly higher than that in the control group (P < 0.05), and the difference was statistically significant in the low, middle and high dose groups than in the control group, and the difference was statistically significant (P < 0.01 / 7.1996.292). After treatment, the ratio of menorrhagia to normal menstruation and increase of menstrual volume in 4 groups were compared respectively, and the proportion of amenorrhea or menorrhagia in low, middle and high dose groups after treatment were compared. The difference was not statistically significant (P 0.05). After treatment, the proportion of amenorrhea or menorrhagia in the four groups was significantly lower than that in the control group (蠂 ~ 2 ~ 2 ~ 39.490 ~ 0.000 ~ 0.000), and the proportion of amenorrhea or menstrual volume in the middle and high dose group was lower than that in the control group. And the difference was statistically significant (蠂 ~ (2 +) ~ (14) 623 ~ 27.265U ~ (21.105)), the adverse reaction rate was significantly higher in the high dose group than that in the middle and high dose group, and was higher in the middle and high dose group than that in the middle dose group, and was higher in the middle dose group than in the middle dose group, and the difference was statistically significant (蠂 ~ (2 +) ~ (2)) ~ (37. 182) P ~ (0.000), P ~ (0.000) and P ~ (0.000) (P < 0.05). The difference was statistically significant (P 0.05), the adverse reaction rate of low and middle dose groups was higher than that of low dose group, and the total effective rate of treatment was not significant in 4 groups of patients due to adverse reactions. There was no significant difference in the total effective rate of treatment in group P0.05. 44, there was no significant difference in the total effective rate of treatment between the two groups. The difference was statistically significant (蠂 ~ (2 +)) 39.490 (P ~ (0.000)). Among them, the total effective rate of low, middle and high dose groups was higher than that of the control group (P < 0.05), and the total effective rate of low, middle and high dose groups was respectively two comparisons. There was no significant difference in pregnancy rate among the four groups (P 0.05). Conclusion estrogen therapy can effectively reduce the recurrence of SIUA and improve menstrual status after TCRA in patients with SIUA. Different doses of estrogen can be used to treat SIUA patients. There was no significant difference in curative effect.
【作者单位】： 南京医科大学第一附属医院妇科;
【基金】：江苏省卫生计生委基金资助项目([2013]8号)~~
【分类号】：R713.4
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本文编号：1593339