不同剂量戊酸雌二醇用于中、重度宫腔粘连术后辅助治疗的临床疗效观察

发布时间：2018-09-08 12:43

【摘要】：目的:探讨雌激素(戊酸雌二醇)用于中、重度宫腔粘连术后的辅助治疗的最佳剂量。方法:选取90例宫腔镜下确诊为中、重度宫腔粘连患者,成功施行宫腔镜下粘连分离术,术后宫腔留置Foley尿管水囊,随机分成3组,每组30例,给予不同剂量雌激素人工周期治疗3个月,A组4 mg/d,B组8 mg/d,C组12 mg/d。定期随访观察患者的月经、宫腔形态、内膜厚度及对有生育要求者随访1年内的妊娠情况。结果:对于中度粘连,B、C组在改善月经、恢复宫腔形态及增加内膜厚度上明显优于A组,差异有统计学意义(P0.05),B、C组间差异无统计学意义(P0.05);对于重度粘连,3组间差异均无统计学意义(P0.05);A、B、C组1年内妊娠率分别为40.0%(4/10),33.3%(4/12)和35.3%(6/17),差异无统计学意义(P0.05)。结论:对于中度宫腔粘连,适当运用大剂量雌激素能明显提高治疗有效率,增加内膜厚度,预防再次粘连,且安全可行;但不必盲目增加雌激素剂量而相应增加药物的不良风险。对于重度宫腔粘连,大剂量雌激素未能明显提高治疗有效率,且3组辅助治疗后均未有效提高术后妊娠率。
[Abstract]:Objective: to investigate the best dosage of estrogen (estradiol valerate) for adjuvant treatment after moderate and severe intrauterine adhesions. Methods: 90 patients with moderate or severe intrauterine adhesions were divided into 3 groups, 30 patients in each group were treated with hysteroscopic adhesion separation successfully. After operation, Foley urethral sac was placed in uterine cavity, and 30 patients in each group were randomly divided into 3 groups, 30 patients in each group were divided into 3 groups. Different doses of estrogen were given for 3 months. Group A, 4 mg/d,B, 8 mg/d,C, 12 mg/d.. The menstruation, uterine cavity morphology, intimal thickness and pregnancy were observed during 1 year follow-up. Results: group C was superior to group A in improving menstruation, restoring the shape of uterine cavity and increasing the thickness of endometrium. There was no significant difference among the three groups (P0.05), but there was no significant difference among the three groups (P0.05). The pregnancy rate in the group A (4 / 10) was 33.3% (4 / 12) and 35. 3% (6 / 17), respectively (P0.05). Conclusion: for moderate intrauterine adhesions, appropriate use of high dose estrogen can significantly improve the effective rate, increase the thickness of endometrium, prevent adhesion again, and be safe and feasible. However, there is no need to blindly increase the dose of estrogen and accordingly increase the adverse risk of drugs. For severe intrauterine adhesions, large doses of estrogen did not significantly improve the effective rate of treatment, and the pregnancy rate was not effectively increased after adjuvant treatment in all three groups.
【作者单位】：湖州市妇幼保健院妇科;
【分类号】：R713.4

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