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目的:观察雌孕激素联合补肾化瘀方治疗宫腔粘连术后患者的临床疗效及对子宫内膜的影响。方法:选取130例行宫腔镜粘连分离术的中、重度宫腔粘连患者,按照随机数字法分为观察组和对照组各65例,对照组给予雌孕激素进行治疗,观察组给予雌孕激素联合补肾祛瘀方进行治疗,2组均治疗3个月经周期,观察治疗前后临床症状改善情况及宫腔粘连改善情况,并在B超下观察比较2组治疗前后子宫内膜厚度、子宫动脉血流指标[动脉搏动指数(PI)、阻力指数(RI)]及子宫内膜穿支血流数,2组均随访1年,统计1年内妊娠率。结果:观察组总有效率为90.8%,高于对照组的69.2%,差异有统计学意义(P<0.05)。2组中医证候积分、宫腔粘连评分均较治疗前下降(P<0.05),观察组2项积分值低于对照组(P<0.05)。2组子宫内膜穿支血流分级、子宫内膜厚度及PI、RI均较治疗前改善(P<0.05),观察组改善较对照组明显(P<0.05)。观察组妊娠率为57.6%,对照组妊娠率为25.0%,2组比较,差异有统计学意义(P<0.05)。结论:雌孕激素联合补肾化瘀方可显著改善宫腔粘连术后患者的临床症状,改善子宫内膜厚度,增加子宫内膜血流,提高妊娠率,其机制可能与促进子宫内膜修复、改善子宫血流灌注量有关。
Objective: To observe the clinical efficacy of estrogen, progesterone combined with Bushen Huayu Recipe in the treatment of patients with intrauterine adhesions and its effect on the endometrium. Methods: 130 cases of hysteroscopy adhesions separation of patients with moderate and severe adhesion of the uterus, according to random number method divided into observation group and control group, 65 cases of estrogen and progesterone in the control group were treated with estrogen and progesterone Combined with Bushenquyu Decoction for treatment, the two groups were treated 3 menstrual cycle, to observe the clinical symptoms before and after treatment and improvement of intrauterine adhesions, and observed in the B ultrasound compared before and after treatment of endometrial thickness, uterine artery Flow index (PI, RI) and endometrial perforating blood flow were recorded. The patients in both groups were followed up for 1 year, and the pregnancy rate was calculated within 1 year. Results: The total effective rate in the observation group was 90.8%, which was higher than that in the control group (69.2%), the difference was statistically significant (P <0.05). The scores of TCM syndromes and intrauterine adhesions in two groups were significantly lower than those before treatment (P <0.05). The two integrals in the observation group were lower than those in the control group (P <0.05). The blood flow grade, endometrial thickness, PI and RI of the endometrial perforating branch in the two groups were improved compared with that before treatment (P <0.05), and the improvement in the observation group was more obvious than that in the control group (P <0.05). The pregnancy rate was 57.6% in the observation group and 25.0% in the control group. There was significant difference between the two groups (P <0.05). Conclusion: The combination of estrogen and progesterone and Bushen Huayu decoction can significantly improve the clinical symptoms, improve the endometrial thickness, increase the blood flow of the endometrium and improve the pregnancy rate in patients with intrauterine adhesions. The mechanism may be related to the promotion of endometrial repair, Improve the amount of uterine blood flow perfusion.