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

Effect of Different Concentrations of Estrogen in Preventing Intrauterine Adhesions after Hysteroscopic Uterine Septum Resection and Its Impact on Pregnancy Outcome

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 preventive effect of different concentrations of estrogen on the intrauterine adhesions after hysteroscopic uterine septum resection and its impact on pregnancy outcome. Methods Total of 80 women of hysteroscopic resection admitted to the Affiliated Xiaogan Hospital of Wuhan University of Science and Technology from Jun. 2012 to Jun. 2014 were included in the study and divided into a control group, a 4 mg group, a 6 mg group, and a 8 mg group according to the random number table method ,20 cases each. The control group was not given estrogen drugs; 4 mg group received estradiol valerate tablets by 4 mg/d ; 6 mg group received estradiol valerate tablets by 6 mg/d ; 8 mg group received estradiol valerate tablets by 8 mg/d. After hysteroscopic review, mediastinal residual ratio, the incidence of intrauterine adhesions were compared. The patients were followed up and the menstruation improvement, adverse medication circumstances, and pregnancy situation of patients with pregnancy requirement were recorded. Results （1）After 3 months, the intrauterine adhesions in the 4 mg group,6 mg group,8 mg group was lower than the control group [ 5.0% （ 1/20）, 10. 0% （ 2/20 ）, 10. 0% （2/20） vs 35.0% （7/20） ], menstruation improvement rates were higher than the control group[65.0% （13/20） ,75.0% （15/20） ,70. 0% （14/20） vs 40. 0% （8/20） ] ,the differences were statistically significant （P 〈 0.05 ）. （2） After 1 year, the intrauterine adhesions in the 4,6,8 mg group was lower than the control group[ 15.0% （3/20） ,20. 0% （4/20）, 20.0% （4/20） vs 55.0% （11/20） ] ,menstruation improvement rates were higher than the control group[ 65.0% （ 13/20）, 65.0% （ 13/20）, 85.0% （ 17/20 ） vs 30. 0% （ 6/20 ） ], the differences were statistically significance （ P 〈 0. 05 ）. （3）The successful pregnancy rate, first pregnancy time, spontaneous abortion rate and delivery rate of different groups had no significant difference（ P 〉 0.05 ）. （4）Adverse effects of different groups had no statistically significant difference （ P 〉 0.05 ）. Conclusion Oral estrogen after hysteroscopic uterine septum resection is effective in preventing intrauterine adhesions and improving menstruation, but cannot significantly improve pregnancy outcomes; within a reasonable range of doses, changes in estrogen dose do not significantly affect its clinical efficacy. Specific dosage should be individualized.