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目的探讨不同浓度雌激素预防宫腔镜下子宫纵隔切除术后宫腔再粘连及其对妊娠结局的影响。方法选择2012年6月至2014年6月武汉科技大学附属孝感医院收治的行宫腔镜下子宫纵隔切除术的80例子宫纵隔患者为研究对象,依据随机数字表法分为对照组、4 mg组、6 mg组、8 mg组,各20例。对照组术后不服用雌激素类药物;4 mg组每日服用4 mg戊酸雌二醇片;6 mg组每日服用6 mg戊酸雌二醇片;8 mg组每日服用8 mg戊酸雌二醇片。术后复查宫腔镜,对比纵隔残余率、宫腔粘连发生率。随访记录患者的月经改善情况、用药不良反应情况,对于有妊娠要求的患者,跟进其妊娠情况。结果 (1)术后3个月,4 mg组、6 mg组、8 mg组宫腔粘连率低于对照组[5.0%(1/20)、10.0%(2/20)、10.0%(2/20)比35.0%(7/20)],月经改善率高于对照组[65.0%(13/20)、75.0%(15/20)、70.0%(14/20)比40.0%(8/20)],差异有统计学意义(P<0.05)。(2)术后1年,4、6、8 mg组宫腔粘连率低于对照组[15.0%(3/20)、20.0%(4/20)、20.0%(4/20)比55.0%(11/20)],月经改善率高于对照组[65.0%(13/20)、65.0%(13/20)、85.0%(17/20)比30.0%(6/20)],差异有统计学意义(P<0.05)。(3)各组妊娠成功率、首次妊娠时间及妊娠者自然流产率、分娩率比较差异无统计学意义(P>0.05)。(4)各组总不良反应发生率比较差异无统计学意义(P>0.05)。结论宫腔镜下子宫纵隔切除术后口服雌激素可有效预防宫腔粘连,改善月经,但对于妊娠结局无明显改善作用;此外可初步确定的是,在合理的剂量范围内,改变雌激素剂量并不明显影响其临床疗效。具体剂量应因人而异,合理使用。
Objective To investigate the effects of different concentrations of estrogen on intrauterine re-adhesion after hysteroscopic hysteroscopic resection of the uterus and its effect on pregnancy outcomes. Methods Eighty patients with hysteroscopic mediastinal hysteroscopic hysteroscopic hysteroscopic hysteroscopic hysteroscopic resection from June 2012 to June 2014 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology were divided into control group and 4 mg group according to random number table , 6 mg group, 8 mg group, each 20 cases. The patients in the control group were given no estrogen after operation. The patients in the 4 mg group took 4 mg estradiol valerate tablets daily, the 6 mg group took 6 mg estradiol valerate tablets daily, and the 8 mg group took 8 mg of ethylene daily Oestradiol tablets. Postoperative hysteroscopy, contrast mediastinal residual rate, intrauterine adhesions incidence. Follow-up records of patients with menstrual improvement, adverse drug reactions, for patients with pregnancy requirements, follow-up of their pregnancy. Results (1) The intrauterine adhesion rate of the 4 mg, 6 mg and 8 mg groups was lower than that of the control group [5.0% (1/20), 10.0% (2/20), 10.0% (2) / 20) than 35.0% (7/20). The improvement rate of menstruation was higher than that of the control group [65.0% (13/20), 75.0% (15/20), 70.0% (14/20) 20)], the difference was statistically significant (P <0.05). (2) The rate of intrauterine adhesions in 4,6,8 mg group was significantly lower than that in control group (15.0% (3/20), 20.0% (4/20), 20.0% (4/20) vs 55.0% (11/20)]. The improvement rate of menstruation was higher than that of the control group [65.0% (13/20), 65.0% (13/20), 85.0% (17/20) vs. 30.0% (6/20)], Statistical significance (P <0.05). (3) There was no significant difference in the success rate of pregnancy, spontaneous abortion rate and spontaneous abortion rate between the first trimester and the third trimester (P> 0.05). (4) There was no significant difference in the incidence of adverse reactions in each group (P> 0.05). Conclusion Hysteroscopic esophageal resection of the uterus after oral estrogen can effectively prevent intrauterine adhesions and improve menstruation, but no significant improvement for the outcome of pregnancy; In addition it can be initially determined that within a reasonable range of doses, changing the estrogen dose Does not significantly affect the clinical efficacy. The specific dose should vary from person to person, rational use.