宫腔镜下宫腔粘连分离术联合雌激素治疗宫腔粘连的疗效观察

Observation on curative effect of hysteroscopic transcervical resection of adhesion combined with estrogen in treatment of intrauterine adhesion

目的探讨宫腔镜下宫腔粘连分离术(TCRA)联合雌激素治疗宫腔粘连(IUA)的疗效,为临床治疗提供参考。方法对2014年1月-2016年12月在开滦总医院林西医院行TCRA联合雌激素治疗的76例IUA患者临床资料进行分析。不同程度IUA患者根据术后应用雌激素剂量不同分为两组,A组戊酸雌二醇8 mg/d,B组4 mg/d,每月用雌激素22 d,后5 d加用黄体酮软胶囊0.2 g/d,连用3个月经周期。观察3个周期后月经及宫腔恢复情况并追踪妊娠情况。结果宫腔恢复良好81.58%(62/76),月经改善73.68%(56/76);随访4~40个月,妊娠36.84%(28/76),活产35.71%(10/28)。宫腔恢复率、月经改善率在Ⅰ度与Ⅱ度之间差异无统计学意义(均P>0.05),但Ⅰ度、Ⅱ度与Ⅲ度之间比较,差异有统计学意义(均P<0.05)。各度IUA中A、B两组间比较,宫腔恢复率、月经改善率差异无统计学意义(均P>0.05)。结论 TCRA联合雌激素治疗IUA效果良好;Ⅰ度、Ⅱ度预后明显好于Ⅲ度;适当增减雌激素剂量对IUA预后无显著影响。

Objective To explore the curative effect of hysteroscopic transcervical resection of adhesion(TCRA） combined with estrogen in treatment of intrauterine adhesion(IUA）,provide a reference for clinical treatment. Methods From January 2014 to December2016,the clinical data of 76 patients with IUA treated by hysteroscopic TCRA combined with estrogen in Linxi Hospital of Kailuan General Hospital was analyzed,then the patients were divided into group A(estradiol valerate,8 mg/d） and group B(estradiol valerate,4 mg/d）according to the dose of poatoperative use of estrogen. Estrogen was applied for 22 days in each month during treatment,then progesterone soft capsules(0. 2 g/d） were given during the final five days. All the patients were treated for three menstrual cycles. The recovery of menstruation and uterine cavity after three menstrual cycles were observed,pregnancy rates were followed up. Results The recovery rate of uterine cavity was 81. 58%(62/76）,and the improvement rate of menstruation was 73. 68%(56/76）. The follow-up time was 4-40 months,the pregnancy rate was 36. 84%(28/76）,and the live birth rate was 35. 71%(10/28）. There was no statistically significant difference in the recovery rate of uterine cavity and improvement rate of menstruation between IUA patients of degree Ⅰ and IUA patients of degree Ⅱ(P〉0. 05）,but there were statistically significant differences between IUA patients of degree Ⅰ,degree Ⅱ and IUA patients of degree Ⅲ(P〈0. 05）. There was no statistically significant difference in the recovery rate of uterine cavity and improvement rate of menstruation between group A and group B(P 〉 0. 05）. Conclusion The curative effect of hysteroscopic TCRA combined with estrogen in treatment of IUA is good,the prognosis of IUA patients of degree Ⅰ,degree Ⅱ are significantly better than that of IUA patients of degree Ⅲ.Increasing or decreasing estrogen dose has no significant impact on the prognosis of IUA.