术前大剂量雌激素、术后放置宫内节育器联合防粘连膜预防宫腔粘连复发的效果分析

Effect of Preoperative High-dose Estrogen,Postoperative Intrauterine Device and Anti-adhesion Membrane in Preventing Recurrence of Intrauterine Adhesion

目的:探讨术前大剂量雌激素、术后放置宫内节育器(IUD)联合防粘连膜对宫腔粘连(IUA)复发的预防效果。方法:选取2018年5月-2020年5月甘肃省妇幼保健院收治的120例拟行宫腔镜宫腔粘连电切术(TCRA)的中重度IUA患者作为研究对象,随机分为A组(直接手术+术后放置IUD,n=30)、B组(直接手术+术后放置IUD+防粘连膜,n=30)、C组(术前大剂量雌激素+术后放置IUD,n=30)、D组(术前大剂量雌激素+术后放置IUD+防粘连膜,n=30)。比较四组手术前后的子宫内膜厚度、临床疗效及手术安全性。结果:A、B组患者术前及术后服用戊酸雌二醇前、服用黄体酮胶囊前子宫内膜厚度均显著低于C、D组,差异有统计学意义(P<0.05)。D组的显效率、总有效率均显著高于A、B、C组,且C组的显效率高于A组,差异有统计学意义(P<0.05)。四组乳房胀痛、抑郁、胃肠道不适等不良反应发生率比较,差异无统计学意义(P>0.05)。结论:术前大剂量雌激素、术后放置IUD联合防粘连膜能显著预防IUA患者TCRA术后粘连复发,安全可靠,值得临床推广应用。

Objective:To investigate the effect of preoperative high-dose estrogen,postoperative intrauterine device(IUD)and anti-adhesion membrane in preventing recurrence of intrauterine adhesion(IUA).Method:One hundred and twenty patients with moderate to severe IUA received transcervical resection of adhesions(TCRA)in Gansu Provincial Maternity and Child Health Hospital were selected as objects and randomly divided into group A(direct surgery+postoperative IUD,n=30),group B(direct surgery+postoperative IUD+anti-adhesion membrane,n=30),group C(preoperative high-dose estrogen+postoperative IUD,n=30),group D(preoperative high-dose estrogen+postoperative IUD+anti-adhesion membrane,n=30).The endometrial thickness,clinical efficacy and surgical safety were compared among four groups.Result:The endometrial thickness before operation,before taking Estradiol Valerate and Progesterone Capsules after menstruation regain after operation of group A and B were significantly lower than those of group C and D,and the differences were statistically significant(P<0.05).The apparent efficiency rate and total effective rate of group D were significantly higher than those of the other group A,B and C,and the apparent efficiency rate of group C was higher than that of group A(P<0.05).There were no significant differences in the incidence of breast distension,depression and gastrointestinal discomfort among the four groups(P>0.05).Conclusion:Preoperative high-dose estrogen,postoperative IUD and anti-adhesion membrane can prevent the adhesion after TCRA in patients with IUA,which is safe,reliable and worthy of clinical application.