大剂量雌激素预防中重度宫腔粘连术后复发的疗效评价

Evaluation of the effect of high dose estrogen in prevention of the recurrence after surgery of moderate or severe intrauterine adhesion

目的评价两种方法口服大剂量雌激素对中重度宫腔粘连分离术后预防粘连复发的疗效。方法对116例中重度宫腔粘连患者行宫腔镜直视下分离粘连术,术后根据治疗方法不同分为两组,实验组（n=58）口服雌激素（戊酸雌二醇）9 mg/d,连续3个月;对照组（n=58）口服雌激素（戊酸雌二醇）9 mg/d,行人工周期治疗3个月,术后第4个月B超检测子宫内膜厚度,再次宫腔镜检查评估宫腔情况。继续随访6~9个月,观察月经、妊娠情况。结果实验组49例宫腔形态恢复正常（治愈率84.48%）、对照组33例（治愈率56.90%）,实验组月经改善51例（有效率87.93%）,对照组36例（有效率62.07%）,差异均有统计学意义（P〈0.05）。实验组子宫内膜修复优于对照组,差异有统计学意义。56例试孕患者中已妊娠24例。结论中重度宫腔粘连者宫腔粘连分离术后使用大剂量雌激素能够有效预防粘连复发,且连续用药效果优于人工周期治疗。

Objective To evaluate the effect of high dose oral estrogen by two methods on preventing adhesion recurrence after transcervical resection for moderate or severe intrauterine adhesion（IUA）. Methods A total of 116 patients with moderate or severe intrauterine adhesion who had been treated with transcervical resection of adhesion were divided into two groups according to different treatments. Patients in study group（n=58） were treated with oral estrogen（estradiol valerate） 9 mg per day for 3 months. Patients in control group（n=58） were treated with oral estrogen（estradiol valerate） 9 mg per day for 3 months by artificial cycle therapy.In the forth month,all patients were given an ultrasound examination to measure the thickness of endometrium and hysteroscopy once again to evaluate uterine cavity. Status of menstruation and pregnancy were observed in the next follow-up period of 6-9 months. Results 49 patients uterine cavities recovered normal in study group（healing rate 84.48%）, compared with 33 patients in control group（healing rate 56.90%）（P〈0.05）. 51 patients’ menstruation improved in study group（effective power 87.93%）, compared with36 patients in control group（effective power 62.07%）（P〈0.05）. Patients endometrium in study group repaired better than those in control group respectively. 24 out of 56 patients had gestation. Conclusion High dose estrogen used in moderate or severe IUA after transcervical resection of adhesion can prevent adhesion recurrence effectively, and the effect of continuous application is better than that of artificial cycle therapy.