宫腔镜电切术联合醋酸甲地孕酮治疗围绝经期异常子宫出血疗效观察

Curative effect of hysteroscopic electrotomy combined with megestrol acetate in the treatment of perimenopausal abnormal uterine bleeding

目的观察宫腔镜电切术联合醋酸甲地孕酮治疗围绝经期异常子宫出血的疗效。方法选择2019年1月至2020年1月于安康市中医医院就诊的100例围绝经期发生异常子宫出血的患者,按随机数表法分为观察组和对照组各50例。对照组患者接受宫腔镜电切术治疗,观察组患者则同时服用醋酸甲地孕酮治疗。比较两组患者治疗3个月后的月经失血图(PBAC)评分、子宫内膜厚度、性激素[促黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇(E2)]水平变化,以及治疗后1年内的疾病复发率、术后并发症和药物不良反应的发生情况。结果治疗后,观察组患者的PBAC评分为(28.43±11.52)分,明显低于对照组的(48.74±14.38)分,差异有统计学意义(P<0.05);治疗后观察组患者的平均子宫内膜厚度为(3.51±0.68)mm,明显低于对照组的(3.94±0.72)mm,差异有统计学意义(P<0.05);治疗后观察组患者的血清LH、FSH、E2水平分别为(8.88±2.32)IU/L、(7.05±2.58)IU/L、(207.20±25.61)pmol/L,明显低于对照组的(13.30±2.38)IU/L、(14.33±3.25)IU/L、(417.80±23.65)pmol/L,差异有统计学意义(P<0.05);两组患者治疗后3个月疾病复发率比较差异无统计学意义(P>0.05)。观察组患者治疗6个月、12个月后的疾病复发率分别为6.00%、12.00%,明显低于对照组的20.00%、28.00%,差异有统计学意义(P<0.05);两组患者术后并发症及药物不良反应发生率比较差异均无统计学意义(P>0.05)。结论宫腔镜电切术联合醋酸甲地孕酮治疗围绝经期出现异常子宫出血的患者,其疗效较单纯手术治疗更好,其不仅可预防疾病复发,限制子宫内膜增厚,降低雌激素水平,且安全性较好。

Objective To observe the curative effect of hysteroscopic electrotomy combined with megestrol acetate in the treatment of perimenopausal abnormal uterine bleeding.Methods A total of 100 patients with perimenopausal abnormal uterine bleeding treated in Ankang Hospital of Traditional Chinese Medicine were enrolled between January 2019 and January 2020.They were divided into observation group and control group according to random number table method,with 50 patients in each group.The control group underwent hysteroscopic electrotomy,while the observation group was additionally treated with megestrol acetate on the basis of control group.The Pictorial Blood Loss Assessment Chart(PBAC),changes of endometrial thickness and sex hormones[luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2)]levels were compared after 3 months of treatment between the two groups,as well as disease recurrence rate within 1 year after treatment,and occurrence of postoperative complications and adverse drug reactions.Results After treatment,PBAC scores in observation group was(28.43±11.52)points,which was significantly lower than(48.74±14.38)points in the control group(P<0.05).After treatment,average endometrial thickness in the observation group was(3.51±0.68)mm,which was significantly thinner than(3.94±0.72)mm in the control group(P<0.05);and levels of serum LH,FSH,and E2 in the observation group were(8.88±2.32)IU/L,(7.05±2.58)IU/L,(207.20±25.61)pmol/L,which were significantly lower than(13.30±2.38)IU/L,(14.33±3.25)IU/L,(417.80±23.65)pmol/L in the control group(P<0.05).There was no significant difference in disease recurrence rate between the two groups at3 months after treatment(P>0.05).At 6 and 12 months after treatment,disease recurrence rates in the observation group were 6.00%and 12.00%,which were significantly lower than 20.00%,28.00% in the control group(P<0.05).There was no significant difference in the incidence of postoperative complications or adverse drug reactions between the two groups(P>0.05).Conclusion Hysteroscopic electrotomy combined with megestrol acetate in the treatment of perimenopausal patients with abnormal uterine bleeding has better curative effect than simple surgical treatment,which can prevent disease recurrence,limit endometrial thickening,reduce estrogen level,and has high safety.