医用透明质酸钠联合地屈孕酮、大剂量戊酸雌二醇在宫腔粘连患者术后的应用观察

Observation on application of medical sodium hyaluronate combined with dydrogesterone and high dose estradiol valerate in patients with intrauterine adhesions after operation

目的探讨医用透明质酸钠联合地屈孕酮、大剂量戊酸雌二醇在宫腔粘连患者术后的应用效果。方法选取2017年12月~2020年1月收治的宫腔粘连患者97例,按随机数字表分为观察组(n=49)和对照组(n=48)。均行宫腔粘连分离术,术后对照组予以地屈孕酮、大剂量戊酸雌二醇,观察组予以医用透明质酸钠联合地屈孕酮、大剂量戊酸雌二醇。对比两组宫腔粘连再发生率、不良反应发生率、子宫机能恢复情况(阴道出血停止时间、月经复潮时间、总出血量、月经量、经期时间)、治疗前后子宫黏膜最大厚度、宫腔粘连程度(AFS)评分。结果观察组宫腔粘连再发生率为6.12%,低于对照组的20.83%(P<0.05);观察组阴道出血停止时间、月经复潮时间短于对照组,总出血量少于对照组,月经量高于对照组,经期时间长于对照组(P<0.001);治疗后观察组子宫黏膜最大厚度大于对照组,AFS评分低于对照组(P<0.01);观察组不良反应发生率2.04%(1/49)与对照组2.08%(1/48)对比,差异无统计学意义(P>0.05)。结论医用透明质酸钠联合地屈孕酮、大剂量戊酸雌二醇能有效预防宫腔粘连患者术后再发粘连风险且利于促进子宫生理机能恢复,不良反应少,安全性高。

Objective To investigate the effect of medical sodium hyaluronate combined with dydrogesterone and high dose estradiol valerate in patients with intrauterine adhesions after operation.Methods 97 patients with intrauterine adhesions in our hospital from December 2017 to January 2020 were selected and divided into observation group(n=49)and control group(n=48)according to random number table.Both groups were treated with intrauterine adhesions separation.After operation,the control group were given dydrogesterone and high dose estradiol valerate,while the observation group were given medical sodium hyaluronate combined with dydrogesterone and high dose estradiol valerate.And then,the recurrence rate of intrauterine adhesions,the incidence of adverse reactions,the recovery of uterine function(stop time of vaginal bleeding,menstrual recovery time,total amount of bleeding,the amount of menstruation and menstrual period),the maximum thickness of uterine mucosa before and after treatment,and the degree of intrauterine adhesions(AFS)score were compared between the two groups.Results The recurrence rate of intrauterine adhesions in the observation group was 6.12%,which was lower than that(20.83%)of the control group(P<0.05).In the observation group,the stopping time of vaginal bleeding and menstrual recovery time were shorter than those in the control group,the total amount of bleeding was less than that in the control group,the amount of menstruation was more than that in the control group,and the menstrual period was longer than that in the control group(P<0.001).After treatment,the maximum thickness of uterine mucosa in the observation group was larger than that in the control group,and the AFS score was lower than that in the control group(P<0.01).The incidence of adverse reactions was 2.04%(1/49)in the observation group and 2.08%(1/48)in the control group,and the difference was not statistically significant(P>0.05).Conclusion Medical sodium hyaluronate combined with dydrogesterone and high dose estradiol valerate can effectively prevent the risk of postoperative recurrence of adhesion in patients with intrauterine adhesions with few adverse reactions and high safety.