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目的:观察诊断性刮宫术(诊刮术)联合小剂量米非司酮治疗围绝经期功能失调性子宫出血的临床疗效和安全性。方法:选择围绝经期功能失调性子宫出血84例,行诊刮术,术后开始给药,每天口服米非司酮6.25mg(1/4片),连服3个月,贫血患者辅以铁剂,服药期间随访阴道出血及药物不良反应情况。3个月后复查超声,检查血常规、性激素六项及肝、肾功能。比较治疗前后血清雌激素(E2)、孕激素(P)、催乳素(PRL)、尿促卵泡素(FSH)、黄体生成素(LH)等性激素水平,以及子宫内膜厚度、血红蛋白等指标变化情况。停药后继续随访6个月。结果:(1)治疗3个月后,本组84例临床症状均得到显著改善,止血时间(5.4±1.1)天。所有入组病例服药期间均出现闭经。停药后绝经38例,占45.2%;月经稀发12例,占14.3%;停药3~6周恢复正常月经32例,占38.1%。停药3个月后又出现不规则阴道出血伴贫血2例,再次诊刮病理检查提示子宫内膜腺囊性增生,行子宫内膜消融术治疗。总有效82例,占97.6%。(2)治疗3个月后,E2、P、PRL水平均较治疗前显著或非常显著下降(P<0.05,P<0.01),LH、FSH水平与治疗前比较差异不显著(P>0.05);复查超声,子宫内膜厚度(0.6±0.2)cm,与治疗前的(1.4±0.3)cm比较差异显著(P<0.05);血红蛋白水平由(78.0±7.3)g/L升至(106.8±4.2)g/L,贫血状况非常显著改善(P<0.01)。(3)本组84例治疗期间均未发生明显胃肠道反应,肝肾功能检查无异常变化。结论:诊刮术联合小剂量米非司酮治疗围绝经期功能失调性子宫出血,疗效肯定,且无显著不良反应。
Objective: To observe the clinical efficacy and safety of diagnostic curettage (curettage) combined with low-dose mifepristone in the treatment of dysfunctional uterine bleeding in perimenopausal period. Methods: Eighty-four patients with dysfunctional uterine bleeding during peri-menopausal period were selected for curettage. After the operation, 6.25 mg of mifepristone (1/4 tablet) was given orally every day for 3 months. Patients with anemia were supplemented with Iron, vaginal bleeding during medication and adverse drug reactions. 3 months after the review ultrasound, check the blood, sex hormones and liver and kidney function. The levels of estrogen (E2), progesterone (P), prolactin (PRL), follicle stimulating hormone (FSH) and luteinizing hormone (LH) and other hormones were compared between before and after treatment and the changes of endometrial thickness and hemoglobin. After discontinuation, follow up for 6 months. Results: (1) After 3 months of treatment, the clinical symptoms of 84 patients in this group were significantly improved with a mean time of bleeding of (5.4 ± 1.1) days. Amenorrhea occurred during the medication in all patients. 38 cases of menopause after discontinuation of medicine, accounting for 45.2%; 12 cases of menstrual thinning, accounting for 14.3%; withdrawal 3 to 6 weeks to restore normal menstruation in 32 cases, accounting for 38.1%. 3 months after discontinuation of irregular vaginal bleeding with anemia in 2 cases, again curettage examination prompted endometrial cyst hyperplasia, endometrial ablation treatment. The total effective 82 cases, accounting for 97.6%. (2) After 3 months of treatment, the levels of E2, P and PRL were significantly or very significantly decreased (P <0.05, P <0.01), while the levels of LH and FSH were not significantly different from those before treatment (P> 0.05) ; The ultrasound and endometrial thickness (0.6 ± 0.2) cm were significantly different from those before treatment (1.4 ± 0.3) cm (P <0.05); The hemoglobin level increased from (78.0 ± 7.3) g / L to 4.2) g / L, anemia was significantly improved (P <0.01). (3) The group of 84 patients during the treatment did not have significant gastrointestinal reactions, liver and kidney function tests showed no abnormal changes. Conclusion: Curettage combined with low dose of mifepristone treatment of dysfunctional uterine bleeding in the perimenopausal period, the effect is positive, and no significant adverse reactions.