戊酸雌二醇联合地屈孕酮与清宫术治疗稽留流产后宫腔内组织残留的临床对照试验

Controlled clinical trials between progynova combined with dydrogestrone and curettage for intrauterine residue after missed abortion

目的对比戊酸雌二醇联合地屈孕酮片药物治疗与清宫术治疗稽留流产后宫腔内组织残留的临床疗效。方法选择120例稽留流产后宫腔内组织残留的患者作为研究对象,根据患者意愿分为2组,观察组66例行戊酸雌二醇联合地屈孕酮治疗,对照组54例行清宫术治疗。比较2组的临床治愈率、宫腔粘连、患者康复情况及生活质量状况。结果观察组治愈57例(86%),对照组治愈49例(91%),2组治愈率比较差异无统计学意义(P> 0. 05)。观察组宫腔粘连发生率及宫腔粘连程度均低于对照组(P均<0. 05)。与对照组相比,治疗后观察组患者的出血量较少、出血时间及月经复潮时间较短、子宫内膜较厚(P均<0. 05)。治疗后,观察组生活质量各项评分中躯体、角色、情绪和总分均高于对照组(P均<0. 05)。结论戊酸雌二醇联合地屈孕酮和清宫术用于稽留流产后均能有效促进宫腔内残留组织排出,戊酸雌二醇联合地屈孕酮不仅避免了子宫内膜的损伤,还能促进月经复潮,有助提高患者生活质量。

Objective To evaluate and compare the clinical efficacy between progynova combined with dydrogestrone and curettage in the treatment of intrauterine residue after missed abortion. Methods A total of 120 patients presenting with intrauterine residual tissuesfollowing missed abortion were enrolled and divided into the observation （n=66） and control groups （n=54） according to their willingness. In the observation group, progynova combined with dydrogesterone intervention was administered, and curettage was performed in the control group.The clinical cure rate, intrauterine adhesions and the rehabilitation and quality of life of patients were statistically compared between two groups. Results In the observation group, 57 cases （86%） were cured and 49 （91%） in the control group with no statistical significance （P〉0.05）. The incidence of intrauterine adhesions in the observation group was significantly lower than that in the control group（P 〈 0.05）, whereas the severity of intrauterine adhesions did not significantly differ between two groups（P 〉 0.05）. Compared with those in the control group, the bleeding volume was significantly less, the bleeding time and menstruation recovery time was considerably shorter and the endometrial thickness was significantly larger in the observation group （all P 〈 0.05）. After corresponding intervention, the total score, the scores of body, role and emotional grade in the observation group were significantly higher than those in the control group （all P 〈 0.05）. Conclusions Bothcombined use of progynova and dydrogestrone and curettage can effectively promote the discharge of intrauterine residual tissues.Progynova in combination with dydrogesterone can not only avoid the endometrial damage of endometrium, promote the recovery of menstruation, but also improve the quality of life of patients.