不同剂量雌激素在中重度宫腔粘连患者术后的应用效果

Clinical efficacy of different doses of estrogen in patients with moderate or severe intrauterine adhesions after hysteroscopy

目的分析不同剂量的雌激素对中重度宫腔粘连(IUA)患者术后的临床疗效。方法分析2016年1月至2017年8月郑州大学第一附属医院收治的150例中重度IUA患者的临床资料,其中中度IUA患者88例,重度IUA患者62例,根据术后雌激素给药剂量将患者分为A组、B组和C组,各50例,给予A组雌激素剂量为4 mg/d,B组6 mg/d,C组9 mg/d,观察3个月经周期后3组患者月经改善情况、宫腔恢复情况、药物不良反应发生率及术后1 a妊娠率。结果中度IUA患者月经改善率、宫腔恢复率均高于重度IUA患者,差异有统计学意义(均P<0.05);B、C组中度IUA患者月经改善率、宫腔恢复率均高于A组中度IUA患者,差异有统计学意义(均P<0.05);B、C组中度IUA患者月经改善率、宫腔恢复率比较,差异无统计学意义(均P>0.05)。3组重度IUA患者月经改善率、宫腔恢复率比较,差异无统计学意义(均P>0.05)。A组无药物不良反应出现,B组药物不良反应发生率低于C组,差异有统计学意义(P<0.05)。3组患者1 a妊娠率比较,差异无统计学意义(P>0.05)。结论中度IUA患者预后优于重度IUA患者。对于中度IUA患者,适量增加雌激素剂量,可有效改善月经情况,恢复宫腔形态;对于重度IUA患者,增加雌激素剂量并未明显提高治疗效果。

Objective To explore the clinical efficacy of different doses of estrogen in patients with moderate or severe intrauterine adhesions(IUA)after hysteroscopy.Methods The clinical data of 150 patients with moderate or severe IUA in the First Affiliated Hospital of Zhengzhou University from January of 2016 to August of 2017 were analyzed.Among them,88 were moderate IUA patients and 62 were severe IUA patients.According to the treatment of estrogen dose after hysteroscopy,the patients were divided into group A,B and C,and each group had 50 cases.The dosage of estrogen was 4 mg/d in group A,6 mg/d in group B,and 9 mg/d in group C.The menstrual improvement,uterine cavity recovery,incidence of adverse drug reactions and one-year pregnancy rate were observed after 3 menstrual cycles.Results The menstrual improvement rate and uterine cavity recovery rate of moderate IUA patients were all higher than those of severe IUA patients,and the differences were statistically significant(all P<0.05).The menstrual improvement rates and uterine cavity recovery rates of moderate IUA patients in group B and C were all higher than those of moderate IUA patients in group A,and the differences were statistically significant(all P<0.05).The menstrual improvement rates and uterine cavity recovery rates in moderate IUA patients in group B and C were compared,and the differences were not statistically significant(both P>0.05).The menstrual improvement rates and uterine cavity recovery rates among severe IUA patients in the three groups were compared,and the differences were not statistically significant(both P>0.05).No adverse drug reactions occurred in group A.The incidence of adverse drug reactions in group B was lower than that in group C,and the difference was statistically significant(P<0.05).The one-year pregnancy rates among three groups were compared,and the differences were not statistically significant(P>0.05).Conclusions The prognosis of moderate IUA patients is better than severe IUA patients.For moderate IUA patients,appropriate increase of estrogen dosage could effectively improve menstruation and restore uterine cavity morphology.For severe IUA patients,increased dosage of estrogen fails to significantly improve the treatment efficacy.