稽留流产围术期口服戊酸雌二醇临床疗效分析

Clinical Effect Analysis on Oral Application of Estradiol Valerate during Peri-curettage for Missed Abortion Patients

目的分析稽留流产清宫术围术期口服戊酸雌二醇的临床疗效。方法回顾性分析2012年1月-2013年12月我院确诊的324例稽留流产行清宫术患者的临床资料。研究组（174例）于清宫术前3 d开始口服戊酸雌二醇2 mg,2次/d,连续4周;对照组（150例）于清宫术前3 d开始口服米非司酮25 mg,2次/d,连续3 d。所有病例均于手术当日术前服用米索前列醇600μg,均于超声引导下行清宫术。两组患者术后均获随诊,观察并比较术后阴道出血时间,术后第一次月经来潮后月经中期子宫内膜最厚的厚度,超声提示子宫最厚内膜≤7 mm或者内膜线中断则行宫腔镜检查。结果研究组与对照组清宫术后阴道流血时间分别为（4.24±1.51）d和（5.41±1.66）d,组间比较差异有统计学意义（P=0.000）;术后第一次月经来潮后子宫内膜最厚的厚度分别为（9.03±1.71）mm和（8.35±2.01）mm,组间比较差异有统计学意义（P=0.001）。研究组行宫腔镜检查22例,发现宫腔粘连5例（2.87%）,其中轻度4例,中度1例;对照组行宫腔镜检查28例,发现宫腔粘连14例（9.33%）,其中轻度9例,中度3例,重度2例。两组宫腔粘连发生率比较,差异具有统计学意义（χ^2=6.089,P=0.014）。结论稽留流产清宫术围术期口服戊酸雌二醇更利于子宫内膜的修复,在一定程度上可以减少术后宫腔粘连的发生。

Objective To analyze the clinical effect of oral application of estradiol valerate during pericurettage for missed abortion patients. Methods The clinical data of 324 women with missed abortion who had diagnosed in Peking University Shenzhen Hospital between January 2012 and December 2013 were analyzed retrospectively. Among them,174 cases regarded as study group received oral estradiol valerate 3 days before curettage with dosage of 2 mg,twice per day for 4 weeks. 150 cases as control group received oral mifepristone 3 days before curettage with dosage of 25 mg,twice per day for 3 days. All cases were administrated misoprostol 600μg before curettage in the operation day. Post-operative vaginal bleeding duration were observed and compared between two groups. The thickest endometrial thickness was measured by ultrasound examination during mid-menstruation after the first menstruation restoration. Hysteroscopy were performed to the cases with thickest endometrial thickness less than 7 mm or broken endometrium line. The intrauterine adhesion rate was compared between two groups. Results The post-operative vaginal bleeding duration was（ 4. 24 ±1. 51） days and（ 5. 41 ± 1. 66） days in study and control group respectively,and there was statistical difference between two groups（ P = 0. 000）. The thickest endometrial thickness during mid-menstruation was（ 9. 03± 1. 71） mm and（ 8. 35 ± 2. 01） mm in study and control group respectively,and there was statistical difference between two groups（ P = 0. 001）. The intrauterine adhesion was found in 5 cases（ mild in 4 and midrange in 1） of study group and in 14 cases（ mild in 9,midrange in 3 and severe in 2） of control group.There was statistical difference in the metrosynizesis rate between two groups（ 2. 87% vs. 9. 33%,χ^2= 6. 089,P = 0. 014）. Conclusions Oral estradiol valerate is beneficial for endometrium reconstruction during pericurettage in missed abortion cases. It can decrease the rate of intrauterine adhesion in some degrees.