稽留流产清宫术后宫腔粘连防治方式选择及效果研究

Study on the Selection and Effect of Prevention and Treatment of Intrauterine Adhesion after Missed Abortion

目的研究探讨稽留流产清宫术后宫腔粘连的防治方式及效果。方法方便选择该院行清宫手术治疗的稽留流产患者80例(2015年1月-2018年9月)进行前瞻性研究,分组方法为随机数字表法,随机划分患者为两组各40例,观察组术后给予黄体酮、戊酸雌二醇片,对照组术后不给予特殊处理,比较两组的宫腔粘连发生率、术后阴道流血时间、腹痛持续时间、月经复潮时间、子宫内膜厚度、性激素指标、血清炎症因子指标、月经减少率、闭经率。结果①宫腔粘连发生率分别为5.00%(观察组)、20.00%(对照组),观察组较对照组更低(χ^2=4.114,P<0.05)。②观察组的术后阴道流血时间(5.29±1.57)d、腹痛持续时间(5.01±1.13)d、月经复潮时间(20.29±3.04)d均较对照组缩短(t=4.933、5.382、5.264,P<0.05)。③治疗后,观察组的子宫内膜厚度(11.08±2.15)mm较对照组更厚(t=4.948,P<0.05),其促黄体生成素(11.27±2.06)U/L、促卵泡激素(5.49±0.51)U/L、雌二醇(268.79±29.42)ng/L均较对照组更低(t=4.787、4.869、5.230,P<0.05)。④在术后24 h、48 h,观察组的CRP[(10.59±2.42),(5.18±2.09)mg/L]、IL-6[(23.18±3.12),(21.25±2.76)ng/L]均较对照组更低(t=4.200、4.755、4.969、4.657,P<0.05)。⑤术后随访3个月,观察组的月经减少率(7.50%)、闭经率(2.50%)均较对照组更低(χ^2=4.501、3.914,P<0.05)。结论在稽留流产患者清宫术后给予其黄体酮+戊酸雌二醇片,可有效预防宫腔粘连,还可有效加快术后阴道出血、腹痛等症状缓解,促使月经尽快复潮。

Objective To study the prevention and treatment of postoperative intrauterine adhesions in the abortion of abortion. Methods A prospective study was conducted in 80 patients with missed abortion who underwent uterine surgery in our hospital(January 2015 to September 2018) were convenient selected. The grouping method was a random number table method. The patients were randomly divided into two groups of 40 patients. The observation group was given progesterone and estradiol valerate tablets. The control group was given no special treatment after operation. The incidence of intrauterine adhesions, postoperative vaginal bleeding time, duration of abdominal pain, menstrual re-tidal time, and intrauterine membrane thickness, sex hormone index, serum inflammatory factor index, menstrual reduction rate, amenorrhea rate were compared between the two groups. Results 1.The incidence of intrauterine adhesions was 5.00%(observation group) and20.00%(control group), respectively. The observation group was lower than the control group(χ^2=4.114, P<0.05). 2.The postoperative vaginal bleeding time(5.29±1.57)d, abdominal pain duration(5.01±1.13)d, and menstrual rehydration time(20.29±3.04)d in the observation group were shorter than the control group(t=4.933, 5.382, 5.264, P<0.05). 3.After treatment, the endometrial thickness of the observation group(11.08±2.15)mm was thicker than the control group(t=4.948, P<0.05), and luteinizing hormone(11.27±2.06)U/L and follicle stimulating hormone(5.49±0.51)U/L. Estradiol(268.79±29.42)ng/L was lower than the control group(t=4.787, 4.869, 5.230, P<0.05). 4.At 24 h and 48 h after operation, CRP [(10.59±2.42),(5.18±2.09)mg/L] and IL-6[(23.18±3.12),(21.25±2.76)ng/L] in the observation group were lower than the control group(t=4.200, 4.755, 4.969, 4.657, P<0.05). 5.After 3 months of follow-up, the menstrual reduction rate(7.50%) and amenorrhea rate(2.50%) were lower in the observation group than in the control group(χ^2=4.501, 3.914, P<0.05). Conclusion The administration of progesterone + estradiol valerate tablets in patients with missed abortion can effectively prevent intrauterine adhesions, and can effectively accelerate postoperative vaginal bleeding, abdominal pain and other symptoms, and prompt menstruation to re-emerge as soon as possible.