几种预防人工流产术后宫腔粘连措施的疗效比较

目的：探讨人工流产术后口服药物以及宫腔注射玻璃酸钠预防宫腔粘连的临床疗效。方法：随访观察施行人工流产终止早期妊娠的患者572例，患者均流产两次及两次以上。按照随机及自愿的方法分为人工周期组、屈螺酮炔雌醇片组、玻璃酸钠组及对照组，比较4组间内膜厚度、月经复潮时间及宫腔粘连的情况。结果：人工周期组子宫内膜厚度大于对照组(P<0.001)；屈螺酮炔雌醇片组子宫内膜厚度小于对照组(P<0.001)。玻璃酸钠组子宫内膜厚度与对照组比较差异无统计学意义(P=0.717)。人工周期组与屈螺酮炔雌醇片组月经复潮时间均短于对照组(P<0.001)；玻璃酸钠组月经复潮时间与对照组差异无统计学意义(P=0.813)。3种预防方式均能明显降低术后宫腔粘连的发生(均P<0.01)。结论：人工流产后即刻给予人工周期药物或者屈螺酮炔雌醇片能够有效促进子宫内膜的修复，减少宫腔粘连的发生。对于依从性较差的患者，屈螺酮炔雌醇片可作为人工流产后预防宫腔粘连发生的首选药物。

Comparison among measures to prevent intrauterine adhesions after artificial abortion

Objective: To investigate the clinical efficacy of oral medicine and sodium hyaluronate in prevention of intrauterine adhesions after artificial abortion.Methods: A total of 572 patients with early pregnancy termination through artificial abortion, who experienced two or more times of abortion, were retrospectively analyzed. Patients were randomly and voluntarily divided into 4 groups: an artificial cycle group, a drospirenone and ethinylestradiol tablets group, a sodium hyaluronate group, and a control group. The thickness of the endometrium, return time of menses, and the status of intrauterine adhesions were observed.Results: The thickness of the endometrium in the artificial period group was greater than that in the control group (P<0.001). It was less in the drospirenone and ethinylestradiol tablets group comparing with that in the control group (P<0.001). There was no significant difference in the thickness of the endometrium between the sodium hyaluronate group and the control group (P=0.717). Return time of menses in the artificial menstrual cycle group and the drospirenone and ethinylestradiol tablets group was shorter than that in the control group (P<0.001). There was no significant difference in return time of menses between the sodium hyaluronate group and the control group (P=0.813). The incidence of intrauterine adhesions could be reduced by the 3 preventive measures (All P<0.01).Conclusion: Drugs for artificial cycle and drospirenone and ethinylestradiol tablets medication immediately after artificial abortion can effectively promote endometrial repair and reduce the incidence of intrauterine adhesions. However, for the patients with poor compliance, drospirenoneand ethinylestradiol tablets are the first choice for prevention of intrauterine adhesion.