戊酸雌二醇片联合米索前列醇及利多卡因用于绝经后取环临床效果的比较

Comparion of clinic effects of progynova combined with misoprostol and lidocaine on intrauterine device removal in postmenopausal women

目的:探讨戊酸雌二醇片联合米索前列醇及利多卡因在绝经后取环中的应用效果,旨在寻找一种较理想的绝经后取环的方法。方法:选取绝经期要求取环妇女216例,随机分为3组:对照组48例,术前无处理;戊酸雌二醇片联合米索前列醇组84例,术前7天每天口服戊酸雌二醇片1mg,术前2h阴道放置米索前列醇400mg戊酸雌二醇片联合米索前列醇及利多卡因组84例,术前7天每天口服戊酸雌二醇片1mg,术前2h阴道放置米索前列醇400mg;术时利多卡因5mL宫旁神经阻滞麻醉;比较3组的宫颈扩张程度,手术时间,术中不良反应及手术成功率有无差异。结果:对照组在宫颈扩张程度,手术时间,术中不良反应及手术成功率与戊酸雌二醇片联合米索前列醇组及戊酸雌二醇片联合米索前列醇和利多卡因组差异均有统计学意义(P<0.01),而戊酸雌二醇片联合米索前列醇及利多卡因组与戊酸雌二醇片联合米索前列醇组相比在宫颈扩张程度,手术时间及手术成功率上差异无统计学意义(P>0.05),但无论在不良反应上及取环难易程度上前者要优于后者(P<0.05)。结论:在绝经后取环术前使用戊酸雌二醇片联合米索前列醇及利多卡因或戊酸雌二醇片联合米索前列醇能有效减轻患者的痛苦,使手术较易进行,其中在减轻术中不适及取环效果上前者要优于后者。

Objective： To explore the effects of progynova combined with miisoprostol and lidocaine on intrauterine device （IUD） removal in postmenopausal women, and to find out a better removal method. Methods： A total of 216 postmenopausal women requiring IUD removal were divided into 3 groups randomly： control group （48 cases） without pretreatment; progynova combined with misoprostol group （84 cases）, taking progynova orally in 7 days before operation, 1 mg once, once a day, and 400 μg misoprostol intravaginally 2 hours before operation; progynova misoprostol and lidocaine group （84 cases）, taking progynova orally in 7 days before operation, 1 mg once, once a day, 400 μg misoprostol intravaginally 2 hours before operation; and in the same time lidocaine 5 mL for paracervical nerve blocking anesthesia dur- ing operation. The cervical dilating degree, operating time, adverse reaction during operation and success rate of operation were compared among three groups. Results： There were differences in cervical dilating degree, operating time, adverse reaction during operation and the difficulty level of IUD removal between control group and progynova ; misoprostol group, or between control group and combination of progynova , misoprostol and lidocaine group （P〈0. 01）. But there was no difference in cervical dilating degree or operating time between combination of progynova,misoprostol group and progynova group and misoprostol ; lidocaine group, while there were differences in adverse reaction during operation （P〈O. 01） and difficulty level of IUD removal between combination of progynova,misoprostol group and progynova group and misoprostol ; lidocaine group （P〈0.05）, Conclusions. Treatment of progynova and misoprostol with or without lidocaine before IUD removal can simplify the operation, effectively relief the pain. In terms of relieving operative malaise and improving the effects of the IUD removal, combination of progynova, misoprostol and lidocaine is superior to combination of progynova and misoprostol only.