晚期小稽留流产清宫术前用补佳乐及米非司酮预处理的临床价值

目的探讨晚期小稽留流产清宫术前应用补佳乐及米非司酮预处理的临床价值。方法将120例晚期小稽留流产患者随机分为预处理组和对照组各60例，预处理组口服5mg补佳乐3次／d及25mg米非司酮2次／d，共3d，第4天行清宫术，对照组直接行清宫术，比较两组手术情况和近、远期并发症。结果与对照组相比，预处理组手术时间短（8．6±2．7）min与（10．5±3．4）min，t=3．390，P=0．001]、术中出血少（47．5±18．3）ml与（61．8±20．5）ml，t=4．031，P=0．000]，差异均有统计学意义。并发症上预处理组的清宫不全发生率（0与13．3％）、人流综合征发生率（3．3％与15．0％），术后宫颈管／宫腔粘连发生率（0与11．7％）和阴道出血持续时间（7．5±2．7）d与（8．7±3．4）d]，均低于对照组差异均有统计学意义（0=6．563，P=0．010，0=4．904，P=0．027，χ^2=5．461，P=0．019，t=2．141，P=0．034）。预处理组患者术后平均月经恢复时间（30．5±9．3）d短于对照组（35．5±7．4）d，差异有统计学意义（t=3．259，P=0．002）。结论术前应用补佳乐及米非司酮预处理可减少晚期小稽留流产患者清宫术并发症，副作用少，有利于术后恢复，值得临床推广。

The clinical value of pretreatment using estradiol valerate and mifepristone before the curettage of the late small missed abortion

Objective To explore the clinical value of preparatory treatment using estradiol valerate and mifepristone before the curettage of the late small missed abortion. Methods One hundred and twenty patients with late small missed abortion were randomly divided into two groups ： pretreated group （ n = 60 ） and control group（n =60）. Women in the pretreated group were given 5 mg of Estradiol Valerate 3 times/day and 25 mg of Mifepristone twice/day for 3 days each before conducted curettage on the fourth day. While for the control group, curettage was done directly. The condition of operation and the occurrence of short-and long-term complications were compared between the two groups. Results Compared with the control group, the pretreated group had a significant shorter operation duration （ 8. 6 ± 2. 7 ） rain vs. （ 10. 5 ± 3.4 ） rain, t = 3. 390, P = 0. 001 1 and less blood lose during operation （ 47. 5 ± 18. 3 ） ml vs. （ 61.8 ± 20. 5 ） ml, t = 4. 031, P 〈 0. 001 ]. In terms of complications, the rates of incomplete curettage （ 0 vs 13.3%, χ^2 = 6. 563, P = 0. 010 ] , artificial abortion syndrome（ 3.3% vs 15.0% , χ^2 = 4. 904, P = 0. 027 ） , the cervical canal adhesion/Asherman＇ s syndrome （0 vs 11.7 % , χ^2 = 5.461, P = 0.019 ） , and the vaginal bleeding duration （7.5 ± 2.7 ） days vs （ 8.7 ± 3.4 ） days, t = 2. 141 ,P = 0. 034] in the pretreated group were significantly lower than those in the control group. The average recovery time of menstruation after operation in the pretreated patients was significantly shorter than that in the control group （30. 5 ± 9. 3 ） days vs. （35.5 ± 7.4） days, t = 3. 259, P = 0. 002 ]. Conclusion Estradiol valerate and Mifepristone as a preparatory treatment before the operation can help reduce the occurrence of complications and side effects in the late small missed abortion curettage and is helpful for the patients＇ recovery, thus worth wide clinical application.