不同剂量经皮雌激素对中重度宫腔粘连术后预后影响的研究

目的比较分析不同剂量的经皮雌激素对于中重度宫腔粘连(IUA)术后患者的治疗效果和预后,探讨安全有效的经皮雌激素治疗方案。方法选择2017年5月至2019年5月在本院初次接受宫腔镜下宫腔粘连分离术(TCRA)治疗的中重度宫腔粘连患者,按照1:1:1随机分配到试验组A(经皮雌激素5 g组)、试验组B(经皮雌激素10 g组)和对照组(口服雌激素组)各80例进入前瞻性研究;比较三组一般临床资料、治疗前后子宫内膜厚度和宫腔探查分级评分、月经恢复、宫腔恢复和三组患者治疗过程中不良反应发生情况。结果 3组治疗前增值晚期子宫内膜厚度和宫腔探查分级评分比较差异均无统计学意义(P>0.05),而治疗后子宫内膜厚度均较术前显著增厚、宫腔探查分级评分较术前显著降低(P均<0.01),且3组间有统计学差异(F=8.677,P=0.000;χ^2=7.716,P=0.021),试验组B子宫内膜厚度显著高于对照组(P<0.01),试验组B宫腔探查评分显著低于试验组A和对照组(P<0.01);3组间月经改善率和宫腔恢复情况差异无统计学意义(χ^2=4.995,P=0.084;χ^2=4.183,P=0.124);试验组A和组B肝功能异常发生率均为1.25%(1/80),显著低于对照组8.75%(7/80)](χ^2=7.782,P=0.020);各组用药前后血脂和凝血指标的变化不明显(P>0.05)。结论对于中、重度宫腔粘连患者,TCRA术后应用经皮雌激素和口服补佳乐均有助于修复子宫内膜、降低分级评分,且前者肝功能损害风险小,不会影响血脂代谢以及凝血功能;较大剂量经皮雌激素更有利于降低分级评分,改善预后,具有更好的应用价值。

Influence of different doses of transdermal estrogen on prognosis in patients with moderate to severe intrauterine adhesions after hysteroscopic surgery

Objective:To compare the treatment effect and prognosis of different does of transdermal estrogen in patients with moderate to severe intrauterine adhesion(IUA)after hysteroscopic surgery,and evaluate the safe regimen of transdermal estrogen.Methods:The patients with moderate to severe IUA who underwent transcervical resection of adhesion(TCRA)for the first time in our hospital from May 2017 to May 2019 were included in the study.The patients were randomly(1:1:1)divided to three groups:test group A(5 mg transdermal estradiol),test group B(10 mg transdermal estradiol)and control group(oral estrogen),80 patients for each group.The general clinical information,endometrial thickness before and after treatment,uterine cavity grading score,recovery of menstrual and uterine cavity,and complications during treatment were compared among the three groups.Results:There was no significant difference in endometrial thickness in the late proliferative phase and grading score of uterine cavity exploration before treatment among the three groups(P>0.05).After treatment,endometrial thickness was significantly thicker than that before operation,and the grading score of uterine exploration was significantly lower than that before operation in all groups(P<0.01),and there was significant difference among the three groups(F=8.677,P=0.000;χ^2=7.716,P=0.021).The endometrial thickness of the patients in test group B were significantly thicker than that of control group(P<0.01).The grading score of uterine exploration of the patients in test group B was significantly lower than that in test group A or control group(P<0.01).There was no significant difference in menstrual improvement and uterine cavity recovery among the three groups(χ^2=4.995,P=0.084;χ^2=4.183,P=0.124).The incidence of liver dysfunction in test group A and B was 1.25%(1/80),which was significantly lower than that in the control group8.75%(7/80)](χ^2=7.782,P=0.020).The changes of blood lipid and coagulation index were not significantly different before and after treatments in each group(P>0.05).Conclusions:For patients with moderate to severe IUA,the treatment of transdermal estradiol and oral estrogen after TCRA can repair the endometrium and reduce grading score of uterine exploration.However,transdermal estradiol has a lower risk of liver damage,and does not affect blood lipid metabolism and coagulation function.Besides that,higher dose of transdermal estrogen is more conducive to reduce grading score,improve prognosis,and has a better value of treatment.