不同剂量戊酸雌二醇联合球囊支架对宫腔粘连分离术术后再粘连及凝血功能的影响

Effects of Different Doses of Estradiol Valerate Combined with Balloon Stent on Readhesion and Coagulation Function After Transcervical Resection of Adhesions

目的探讨不同剂量戊酸雌二醇联合球囊支架对宫腔粘连分离术(transcervical resection of adhesions,TCRA)术后再粘连的预防作用及对凝血功能的影响。方法回顾性分析2015年2月至2017年2月行TCRA治疗的114例宫腔粘连患者的临床及随访资料,根据给药剂量的不同将其分为低、中、高剂量组,各38例。低、中、高剂量组患者行TCRA术后均放置球囊支架,分别加用戊酸雌二醇1,2,4 mg/d治疗,治疗3个疗程。结果高、中剂量组总有效率明显高于低剂量组(97. 37%,94. 74%比73. 68%,P <0. 05),宫腔再粘连率明显低于低剂量组(15. 79%,15. 79%比36. 84%,P<0. 05),但高、中剂量组比较无显著差异(P>0. 05);3组患者治疗前后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及纤维蛋白原(FIB)水平均在正常范围内,差异均无显著性(P> 0. 05);高剂量组不良反应发生率明显高于低、中剂量组(44. 74%比15. 79%,10. 53%,P <0. 05),但低、中剂量组比较无显著差异(P> 0. 05)。结论 TCRA术后应用2 mg戊酸雌二醇联合球囊支架的临床效果确切,可有效预防TCRA术后宫腔再粘连,且药品不良反应小,不影响凝血功能。

Objective To investigate the effects of different doses of estradiol valerate combined with balloon stent on preventing readhesion after transcervical resection of adhesions（ TCRA） and coagulation function. Methods The clinical and follow-up data of 114 patients with intrauterine adhesions undergoing TCRA in our hospital from February 2015 to February 2017 were retrospectively analyzed. According to the different administration methods,the patients were divided into low dose group,medium dose group and high dose group,38 cases in each group. The stent were placed after TCRA for patients in the three groups. The low dose group,medium dose group and high dose group were treated with 1,2,4 mg/d estradiol valerate. The three groups were treated for 3 courses. Results The total effective rates of medium dose group and high dose group were significantly higher than that of low dose group（ 97. 37%,94. 74% vs.73. 68%,P〈0. 05）,the intrauterine re-adhesion rates of medium dose group and high dose group were significantly lower than that of low dose group（ 15. 79%,15. 79% vs. 36. 84%,P〈0. 05）,and there was no significant difference between medium dose group and high dose group（ P〉0. 05）. The PT,APTT,TT and levels of FIB in the three groups were in the normal range before and after treatment,and there was no significant difference（ P〉0. 05）. The incidence rate of adverse reaction in the high dose group was significantly higher than those of low dose group and medium dose group（ 44. 74% vs. 15. 79%,10. 53%,P〈0. 05）,but there was no significant difference between low dose group and medium dose group（ P〉0. 05）. Conclusion The application of 2 mg estradiol valerate combined with balloon stent after TCRA has accurate effect,which can effectively prevent intrauterine readhesion after with few adverse reactions,and it does not affect the coagulation function of patients.