不同方式口服雌激素对宫腔镜下宫颈宫腔粘连分离术后治疗效果的研究

The treatment effect of oral estrogens at different way after separation of cervical and uterine adhesions under hysteroscope

目的探讨不同方式口服雌激素对宫腔镜下宫颈宫腔粘连分离术后的治疗效果。方法选取2016年1月—2018年3月本院收治的中度或重度宫腔粘连患者120例作为研究对象,随机分为人工周期组和持续用药组两组,每组各60例。两组均行宫腔镜下宫颈宫腔粘连分离术,人工周期组术后第2天或月经第5天开始口服E2V(5 mg/次,q 12 h×21 d),后10天加服MPA(10 mg/d)。持续用药组第2天或月经第5天开始口服E2V(5 mg/次,q 12 h),子宫内膜厚度达到6.5～7 mm或以上加服MPA(10 mg/d,10 d)。观察两组月经、宫腔粘连及妊娠情况。结果两组治疗前、服用E2V前和加服MPA前子宫内膜厚度比较差异无统计学意义(P>0.05);两组治疗前后月经量比较差异无统计学意义(P>0.05);人工周期组和持续用药组治疗后月经量分别为(40.15±17.81) ml和(39.82±15.70) ml,均较治疗前[(14.12±2.03) ml,(13.87±2.15 ml)]明显增加,差异有统计学意义(P<0.05);人工周期组治疗总有效率为65.00%,持续用药组治疗总有效率为50.00%,差异比较无统计学意义(P>0.05);人工周期组妊娠率为8.33%,持续用药组妊娠率为5.00%,差异无统计学意义(P>0.05)。结论连续性雌激素治疗与周期性雌激素治疗均可促进子宫内膜的修复和月经量的增加,且对于妊娠结局的改善效果较为相似。

Objective To investigate the treatment effect of oral estrogens at different way after separation of cervical and uterine adhesions under hysteroscope.Methods 120 patients with moderate or severe intrauterine adhesions,treated in our hospital during January 2016 and March 2018,were selected in this study.They were divided into artificial cycle group(60 cases) and continuous treatment group(60 cases),patients in both groups underwent cervical intrauterine adhesions dissection under hysteroscope.Patients in artificial cycle group orally took E2 V(5 mg/time,q 12 h × 21 d) started at the second day after operate or at the fifth day of menstruation,and took MPA ten days later at the dose of 10 mg/d until the end.Patients in the continuous treatment group orally took E2 V(5 mg/time,q 12 h) started at the second day after operate or at the fifth day of menstruation,and when the endometrial thickness reached 6.5 mm to 7 mm or more,the patients took MPA(10 mg/d,10 d) additionally.The status of menstruation,intrauterine adhesions and pregnancy of the two groups observed.Results The differences endometrial thickness between the two groups before treatment,before took E2 V and MPA were not statistically significant(P>0.05).There was no statistical significance between two groups before and after treatment in menstrual volume(P > 0.05).After the treatment,the amount of menstruation in artificial cycle group and continuous treatment group were(40.15 ± 17.81) m L and(39.82 ± 15.70) m L,which significantly increased compared with(14.12 ± 2.03) m L and(13.87 ± 2.15) m L before treatment,the differences were statistically significant(P<0.05).The total effective rate of artificial cycle group was 65.00%,and it was 50.00% in continuous treatment group,the difference was not statistically significant(P>0.05).The pregnancy rate in artificial cycle group was 8.33%,and it was 5.00% in the continuous treatment group,the difference between the two groups was not statistically significant(P>0.05).Conclusions Both continuous oral administration and cycle oral administration of estrogen could promote endometrial repair and increase the amount of menstruation.And they play a similar efficacy in improving the pregnancy outcome.