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

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。

Investigate of clinical effect of different doses of estrogen to prevent re-adhesions after hysteroscopy surgeries of severe intrauterine adhesions

Objective To investigate the clinical effect of water balloon , intrauterine device combined with different doses of estrogen in preventing re -adhesions in patients with severe intrauterine adhesions after hysteroscopy surgeries .Methods 60 patients with severe intrauterine adhesions diagnosed through hysteroscopy examination , who were treated with laparoscopic transcervical resection of adhesion from January 2008 to January 2013 in People's hospital of Zunhua City were selected.According to different applications of estrogen , the patients were divided into research group and control group , each group with 30 cases.The research group patients were given 3 mg estradiol valerate ( EV)-3 times per day for three months after the first day of operation , and the last ten days 200 mg progesterone capsules were added once a day .After ten days , it was going to be menstrual bleeding .The control group patients were treated with conventional dose for 3 cycles.2 mg EV 3 times per day for 21 days, and 200 mg progesterone capsules were added once a day for last ten days in every cycle .Three months after the operation , re-examined the condition of intrauterine adhesions , conducted hysteroscopy and taken out intrauterine device .Mild adhesions were separated by hysteroscopy .Observe the menstruation 3 months after the operation .Draw blood of patients on an empty stomach before and after taking medications , detected index of prothrombin time(PT), activated partial thromboplastin time (APTT), thrombin time(TT), fibrinogen(Fib), Alanine transaminase (ALT), Aspertate Aminotransferase(AST), triglyceride(TG) and total cholesterol(TC).Results In the research group, three cases got intrauterine adhesions again after hysteroscopy surgery , and the re -adhesion rate was 10 %.In the control group , after hysteroscopy surgery five cases got intrauterine adhesions again , and the re -adhesion rate was 16.67 %.There was no significant difference between the two groups .29 cases of the research group had improved menstruation , the effective rate was 96.67 %, 22 cases of the control group had improved menstruation , the effective rate was 73.3 %, there was significant difference between the two groups.And there were no significant differences between the two groups in indexes of PT , APTT, Fib, TT, ALT, AST, TG and TC before and after treatment ( P >0.05 ) .Conclusion The menstrual situation of patients with severe intrauterine adhesions after hysteroscopy surgeries can be improved through using water balloon , intrauterine device combined with large dose of estrogen .This method is safe and effective .