水囊联合大剂量雌激素对宫腔粘连分离术患者子宫内膜功能的影响

Effect of water bag combined with large amount of estrogen on endometrial function in patients with intrauterine adhesions

目的探讨宫腔镜下持续放置水囊联合大剂量雌激素对宫腔粘连分离术患者子宫内膜功能恢复的影响。方法回顾性分析2014年4月至2015年6月在该院接受宫腔粘连分离术患者的临床资料,所有患者均在术后给予宫腔内持续放置水囊,并根据其激素用量的不同分为低剂量雌激素治疗组和大剂量雌激素治疗组,1个月为1个疗程,所有患者均接受3个疗程的治疗。观察两组患者月经恢复情况、再粘连发生率和宫腔形态满意率,比较两组患者B超内膜厚度、激素水平的差异。结果大剂量激素治疗组患者月经改善率为97.8%,明显大于低剂量雌激素治疗组(85.0%),差异有统计学意义(χ~2=4.575,P=0.032);两组患者再粘连发生率比较,差异无统计学意义(χ~2=0.357,P=0.550);大剂量雌激素治疗组患者宫腔满意率为97.8%,明显高于低剂量雌激素治疗组(82.5%),差异有统计学意义(χ~2=5.797,P=0.016);大剂量雌激素治疗组患者的子宫内膜厚度高于低剂量雌激素治疗组(t=-17.720,P<0.05);大剂量激素治疗组患者腺上皮和间质细胞的雌激素受体(ER)和孕激素受体(PR)表达水平均高于低剂量激素治疗组(t=-6.283、-6.784、-6.364、-6.037,P<0.05)。结论宫腔镜下持续放置水囊联合大量雌激素治疗可明显改善宫腔粘连分离术后患者的宫腔状况,促进宫腔粘连分离术后患者的子宫内膜功能的恢复。

Objective To investigate the effect of continuous placement of water sac combined with a large number of estrogen on uterine endometrial function recovery in patients with intrauterine adhesions.Methods Clinical data of patients with intrauterine adhesions treated in our hospital from April 2014 to June 2015 were analyzed retrospectively,all patients were given intrauterine continued placing a water sac postoperatively and according to different hormone dosage,patients were divided into low dose estrogen treatment group and high dose estrogen treatment group therapy.One month was a course of treatment,and all patients were treated with three courses of treatment.Two groups of patients with menstruation recovery,recurrence rate,the rate of uterine cavity form satisfaction endometrial thickness and hormone levels of were compared.Results The menstrual improvement rate of the high dose of hormone treatment group was 97.8%,which was significantly higher than the low dose estrogen treatment group(85.0%)(χ~2=4.575,P=0.032).Adhesion rates of two groups had no statistical significance(χ~2=0.357,P=0.550)and satisfaction rate of high dose estrogen treatment group was 97.8%,which was significantly higher than the low dose estrogen treatment group(82.5%)(χ~2=5.797,P=0.016).Endometrial thickness of high dose estrogen therapy group was higher than low dose estrogen treatment group(t=-17.720,P<0.05),and ER and PR expression levels in glandular epithelium and interstitial cells of high dose of hormone treatment group of were significantly higher than those in low dose hormone therapy group(t=-6.283,-6.784,-6.364,-6.037,P<0.05).Conclusion The continuous placement of water sac combined with a large amount of estrogen could obviously improve the uterine cavity adhesion of patients after the separation,and promote the recovery of endometrial function in patients after uterine cavity adhesion separation.