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目的:探讨术前阴道预处理降低绝经后妇女取节育器(IUD)风险及痛苦的方法。方法:将240例绝经后取器的妇女随机分为3组,每组80例,A组:术前2周起每日使用20 g/L丙酸睾丸素鱼肝油软膏1 g/d,阴道涂抹,于取IUD前2～3 h阴道置入米索前列醇200μg;B组:术前连续7 d口服戊酸雌二醇(E2V)3 mg/d,直至手术日;C组:给予不含丙酸睾丸素鱼肝油软膏1 g/d阴道涂抹。观察手术时宫颈松弛程度、取器顺利程度、术中出血量、手术时间,采用目测模拟疼痛程度分级法评价各组疼痛程度;免疫发光分析法测定用药前、后血清雌二醇(E2)和睾酮(T)水平,B超测定子宫内膜厚度。结果:A组宫颈松弛程度、取器顺利程度、术中出血量、手术时间和疼痛程度显著优于C组(P<0.01),且出血少于B组(P<0.05)。外周性激素水平与子宫内膜无明显变化(P>0.05)。结论:术前阴道给予20 g/L丙酸睾丸素配伍米索前列醇用于绝经后妇女取IUD,降低了手术难度,减轻了患者的痛苦,安全有效,值得进一步研究与推广应用。
Objective: To investigate the preoperative vaginal preconditioning to reduce the risk and suffering of IUD in postmenopausal women. Methods: A total of 240 postmenopausal women were randomly divided into three groups, 80 cases in each group. Group A: 20 g / L testosterone propionate cod liver oil ointment 1 g / d daily from 2 weeks before operation, vaginal smear , 200μg of misoprostol was injected into the vagina 2 ~ 3 h before taking IUD. Group B: 3 mg / d of estradiol valerate (E2V) was given orally for 7 days before operation. Group C: Testosterone propionate cod liver oil ointment 1 g / d vaginal smear. The degree of cervical relaxation, the smoothness of the device, the amount of blood loss and the operation time during operation were observed. The degree of pain in each group was evaluated by visual analogue grading method. The levels of estradiol (E2) and Testosterone (T) levels, B ultrasound determination of endometrial thickness. Results: The degree of cervical relaxation, the smoothness of the device, the amount of bleeding during operation, the operation time and the degree of pain in group A were significantly better than those in group C (P <0.01), and the bleeding was less than that in group B (P <0.05). There was no significant difference between peripheral hormones and endometrium (P> 0.05). Conclusions: Preoperative vaginal administration of 20 g / L testosterone propionate in combination with misoprostol for IUD in postmenopausal women reduces the difficulty of operation and reduces the suffering of patients, which is safe and effective. It is worth further study and application.