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(P<0.05),B、C组间差异无统计学意义(P>0.05);对于重度粘连,3组间差异均无统计学意义(P>0.05);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(P>0.05)。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。
Objective： To investigate the effect of artificial cycle treatment with different doses of estrogen （estradiol valerate） in preventing secondary adhesions after the surgical seperation of moderate or severe intra- uterine adhesions. Methods： A prospective randomized controlled trial was conducted. Ninty cases with moderate or serious intrauterine adhesion were confirmed by hysteroscope and underwent transcervical resection of adhesions, foley catheter balloons were inserted postoperatively. All cases were randomly divided into three groups and received artificial treatment for 3 months. In group A, 30 cases were all given estrogen 4 mg/d. In group B, 30 cases were all given estrogen 8 mg/d while in group C, 30 cases received estrogen 12 mg/d, All cases were analyzed by menstruation, morphology of the uterine cavity, endometrial thickness and the one-year outcome of fertility for patients with fertility requirements. Results： For the moderate intrauterine adhesion, the menstruation, morphology of the uterine cavity and endometrial thickness were significantly improved between groups B and C compared with group A （P〈0.05）. No significances were found in groups B and C （P〉0.05）. For the severe intrauterine adhesion patients, no statistically significant difference was observed among the three groups （P〉0.05）. One- year pregnancy rate after operation in groups A, B, C was 40.0% （4/10）, 33.3% （4/12） and 35.3% （6/17）, respectively, without statistically significant difference （P〉0.05）. Conclusion： For the moderate intrauterine adhesion patients, large dose of estrogen improved the efficiency in preventing secondary intrauterine adhesions and increasing the endometrial thickness. Don＇t blindly increase estrogen dose, and accordingly increase the risk of adverse drug. For the severe intrauterine adhesion patients, large dose of estrogen failed to significantly improve the treatment efficiency. Although there were no significances in the one-year outcome of fertility,further study with large sample was still needed to confirm our results.
出处
《生殖与避孕》
CAS
CSCD
北大核心
2015年第3期166-171,共6页
Reproduction and Contraception
