天然孕酮对绝经期子宫内膜增厚的治疗效果评价

目的探讨天然孕酮在绝经期子宫内膜增厚治疗中的临床应用价值。方法对102例绝经期女性B超提示子宫内膜增厚者进行天然孕酮胶丸口服治疗,200 mg/d,共12 d,停药2周后观察子宫内膜厚度变化。结果 83例治疗后内膜转为正常厚度,有效率81.37%,差异有统计学意义(P<0.05)。治疗后有阴道流血病例的内膜转化有效率高于无阴道流血病例,差异有统计学意义(P<0.05)。19例无效者行诊断性刮宫术,其中4例为萎缩性子宫内膜,6例为分泌期子宫内膜,4例为子宫内膜单纯性增生,2例为子宫内膜不典型增生,3例为子宫内膜息肉。用药后无效者中无阴道流血患者病理性子宫内膜例数明显多于有阴道流血的例数,差异有统计学意义(P<0.05)。结论口服天然孕激素治疗作为绝经后妇女单纯子宫内膜增厚的治疗手段是有效的,对用药后无阴道流血的内膜增厚病例进行诊断性刮宫术,可提高子宫内膜病变的检出率。

Clinical value of therapy effect of natural progesterone on endometrial thickening in postmenopausal women

Objective To investigate clinical application value of natural progesterone for treatment of endometrial thickening in postmenopausal women. Methods Totally 102 menopausal women by Ultrasound examined revealed endometrial thickening were treated with natural progesterone capsule oral therapy, 200 mg/d for 12 days. After 2 weeks of the discontinuation, endometrial thickness changes were observed. Results Among the 102 patients, endometrial thickening were changed into normal endometrial thickness in 83 patients, and the effective rate was 81.4% （P 〈 0. 05 ）. The endometrial conversion efficiency of patients with vaginal bleeding after the treatment was higher than those cases without vaginal bleeding （ P 〈 0. 05 ）. Totally 19 cases by drug treatment was invalid under diagnostic curettage, including 4 eases of atrophic endometrium, 6 cases of secretory phase endometrium, 4 cases of endometrial hyperplasia, 2 cases of atypical endometrial hyperplasia, 3 cases endometrial polyps. In the medication invalid cases, no cases of vaginal bleeding detected pathologic results than those with vaginal bleeding cases detected pathologic results and the difference was significant （ P 〈 0. 05 ）. Conclusion The oral natural progesterone therapy for post - menopausal women simply endometrial thickening treatment is effective. Diagnostic curettage surgery must be performed to improve detection rate for endometrial diseases in the endemetrial thickening cases without vagina bleeding after drug treatment.