稽留流产清宫术后应用雌二醇片/雌二醇地屈孕酮片或交联透明质酸钠凝胶的临床疗效观察

Efficacy of estradiol tablet/estradiol and dydrogesterone tablet or crosslinked sodium hyaluronate gel barrier after uterine curettage for missed abortion

目的观察早期妊娠稽留流产清宫术后应用雌二醇片/雌二醇地屈孕酮片或交联透明质酸钠凝胶的临床疗效。方法选取2017年1至12月在杭州市妇产科医院行药物流产+清宫术的稽留流产患者180例,采用随机数字表法将患者分为雌二醇片/雌二醇地屈孕酮片组、交联透明质酸钠凝胶组和对照组,每组60例。3组患者行清宫术后均服用抗菌药物3 d+复方生化汤7 d。雌二醇片/雌二醇地屈孕酮片组患者在手术当晚8:00开始服用雌二醇片/雌二醇地屈孕酮片,每28 d为1个疗程,连服2~3个疗程;交联透明质酸钠凝胶组在清宫术后即刻宫腔内使用交联透明质酸钠凝胶3.0 ml;对照组术后不予以其他特殊处理。比较3组患者术后阴道流血持续时间、月经恢复时间、月经量、子宫内膜厚度、宫腔积液、宫腔粘连(IUA)及再次妊娠情况。结果雌二醇片/雌二醇地屈孕酮片组和交联透明质酸钠凝胶组患者术后阴道流血持续时间均明显短于对照组,术后2周子宫内膜厚度均明显厚于对照组,差异均有统计学意义(均P<0.01);雌二醇片/雌二醇地屈孕酮片组患者术后阴道流血持续时间明显短于交联透明质酸钠凝胶组,术后2周子宫内膜明显厚于交联透明质酸钠凝胶组,差异均有统计学意义(均P<0.01)。雌二醇片/雌二醇地屈孕酮片组和交联透明质酸钠凝胶组患者术后3个月IUA发生率均明显低于对照组,术后6个月再孕率均明显高于对照组,差异均有统计学意义(均P<0.01)。所有患者在术后2年内均再次妊娠。结论早期稽留流产患者清宫术后应用雌二醇片/雌二醇地屈孕酮片或交联透明质酸钠凝胶,可有效预防IUA,增加再次妊娠率。

Objective To evaluate the clinical efficacy of estradiol tablet/estradiol and dydrogesterone tablet or crosslinked sodium hyaluronate gel barrier after uterine curettage for missed abortion.Methods One hundred eighty missed abortion patients who underwent medical abortion+uterine evacuation in Hangzhou Women's Hospital from January to December 2017 were selected,and the patients were divided into estradiol tablet/estradiol dydrogesterone tablet group,Crosslinked sodium hyaluronate gel group and control group,60 cases in each group.All patients in the 3 groups took anti-inflammatory drugs for 3 days and compound Shenghua Decoction for 7 days after purging the palace.Patients in the estradiol tablet/estradiol dydrogesterone tablet group started to take estradiol tablet/estradiol dydrogesterone tablet at 8 o'clock on the night of the operation,and every 28 days is a course of treatment,consecutively taking 2 to 3 tablets cycle.The crosslinked sodium hyaluronate gel group received 3.0 ml of crosslinked sodium hyaluronate gel in the uterine cavity immediately after uterine purgation.The control group received no other special treatment after surgery.The duration of postoperative vaginal bleeding,menstrual recovery time,menstrual volume,endometrial thickness,uterine effusion,intrauterine adhesions(IUA)and re-pregnancy were compared among the three groups.Results The duration of postoperative vaginal bleeding in the estradiol tablet/estradiol dydrogesterone tablet group and the crosslinked sodium hyaluronate gel group was significantly shorter than the control group,and the endometrial thickness was significantly thicker than the control group at 2 weeks after the operation(all P<0.01).The duration of postoperative vaginal bleeding in the estradiol tablet/estradiol dydrogesterone tablet group was significantly shorter than that of the crosslinked sodium hyaluronate gel group,and the endometrium thickness was significantly thicker than the crosslinked sodium hyaluronate gel group(both P<0.01).The incidence of IUA in the estradiol tablet/estradiol dydrogesterone tablet group and the crosslinked sodium hyaluronate gel group was significantly lower than the control group at 3 months after surgery,and the re-pregnancy rate at 6 months after surgery was significant higher than the control group(both P<0.01).All patients were pregnant again within 2 years after surgery.Conclusion The prompt use of estradiol tablet/estradiol and dydrogesterone tablet or crosslinked sodium hyaluronate gel after curettage in patients with missed abortion of early pregnancy are able to effectively prevent IUA and improve the rate of re-pregnancy.