雌孕激素联合应用与清宫术治疗稽留流产后宫内组织残留的临床疗效

Comparison of the clinical effects of estrogen and progesterone combined with conservative treatment and uterus curettage in the treatment of intrauterine residue after missed abortion

目的:分析补佳乐(戊酸雌二醇片)联合地屈孕酮治疗防治稽留流产患者清宫术后宫内组织粘连的临床疗效。方法:选择本院收治的稽留流产后行清宫术患者120例为研究对象,随机分为对照组(54例)与观察组(66例),对照组术后给予常规药物治疗行清宫术,观察组术后给予补佳乐联合黄体酮药物予以补佳乐联合地屈孕酮治疗,比较两组患者治疗后出血量术后出血、月经复潮时间,并通过复诊术后3周检查子宫内膜及宫腔镜检查组织残留情况。结果:术后7d比较两组患者术后出血量,对照组(81.4±16.5)mL,月经复潮时间(26.3±4.5)d,均显著低于观察组(97.5±19.3)mL、(20.4±4.7)d,差异显著(P<0.05);疗程结束后,对照组子宫内膜厚度(6.21±1.16)mm,发生宫腔粘连6例,观察组子宫内膜厚度(9.13±1.12)mm,宫腔粘连1例,均显著低于对照组(P<0.05);复诊结果显示,观察组治愈率86.36%,对照组87.30%,两组比较无显著差异(P>0.05)。结论:补佳乐联合地屈孕酮保守治疗与清宫术治疗稽留产后宫腔粘临床疗效比较,两种方法均有较高的治愈率,但联合药治疗可显著减少阴道出血量,缩短月经复潮时间,降低宫腔粘连发生率,促进患者康复。补佳乐联合地屈孕酮可有效改善清宫术治疗稽留流产后宫腔内组织残留情况,减少术后出血,促进患者经期恢复,降低宫腔粘连发生率,值得临床应用。

Objective：To analyze the clinical effects of Progynova（estradiol valerate tablets） combined with progesterone in controlling intrauterine adhesion in patients with missed abortion after uterus curettage.Methods：120 patients undergoing uterus curettage after missed abortion in our hospital were selected as study subjects and were randomly divided into the control group（54 cases） and the observation group（66 cases）.The control group was treated with routine drugs after operation,while the observation group was treated with Progynova combined with progesterone.The postoperative bleeding,time of menstruation turn over,the endometrium and tissue residue detected by hysteroscopy were compared between the two groups.Results：7 d after operation,the blood loss and time of menstruation turn over of the control group [（81.4±16.5） mL,（26.3±4.5）d] were significantly less and shorter than those of the observation group [（97.5±19.3） mL,（20.4±4.7） d]（P〈0.05）.After treatment,the endometrial thickness of the control group was（6.21±1.16） mm and there were 6 cases with intrauterine adhesion while in the observation group,they were（9.13±1.12） mm and 1 case respectively（P〈0.05）.Conclusion：Progynova combined with progesterone can effectively reduce intrauterine residue after missed abortion,reduce postoperative blood loss,promote recovery of menstruation and reduce the incidence of intrauterine adhesion.