术前戊酸雌二醇预处理结合宫腔镜治疗人流术后宫腔粘连的效果研究

Study on the effect of preoperative estradiol valerate pretreatment combined with hysteroscopy in the treatment of intrauterine adhesion after abortion

目的分析术前戊酸雌二醇预处理结合宫腔镜治疗人工流产术(人流术)后宫腔粘连(IUA)的效果,旨在为相关人员的研究工作提供参考。方法选取56例人流术后宫腔粘连的患者,根据治疗方法不同分为研究组与对照组,每组28例。研究组患者月经第2天口服戊酸雌二醇21 d的后10 d加服黄体酮胶囊为1个人工周期,治疗2个周期后行宫腔镜手术,术后继续人工周期治疗2~3个疗程。对照组患者仅术后行人工周期治疗。两组患者在月经干净后行宫腔镜手术,闭经患者择期手术。比较两组患者临床效果。结果干预前,两组患者血清基质金属蛋白酶-9(MMP-9)、转化生长因子β1(TGF-β1)及血管内皮生长因子(VEGF)水平比较,差异无统计学意义(P>0.05);干预后3个月,相比对照组,研究组患者血清MMP-9、TGF-β1及VEGF水平降低,差异具有统计学意义(P<0.05)。干预前,两组患者的子宫内膜厚度、阻力指数(RI)及搏动指数(PI)值比较,差异无统计学意义(P>0.05);干预后3个月,相比对照组,研究组患者的子宫内膜更厚,PI及RI值明显降低,差异具有统计学意义(P<0.05)。研究组干预后月经改善率为92.86%,对照组为71.43%,研究组患者干预后月经改善率明显高于对照组,差异具有统计学意义(P<0.05)。与对照组相比,研究组患者干预后宫腔再粘连发生率更低,差异具有统计学意义(P<0.05)。结论术前戊酸雌二醇预处理结合宫腔镜治疗人流术后宫腔粘连的效果确切,可改善患者血流参数,增加子宫内膜厚度,改善月经,降低宫腔再粘连发生率,值得临床推广与应用。

Objective To analyze the effect of preoperative pretreatment of estradiol valerate combined with hysteroscopy in the treatment of intrauterine adhesion(IUA)after induced abortion(abortion),in order to provide reference for related personnel.Methods 56 patients with intrauterine adhesion after abortion were selected and divided into study group and control group according to different treatment methods,with 28 cases in each group.The patients in the study group took estradiol valerate orally for 21 days on the second day of menstruation and progesterone capsules for 10 days after the first artificial cycle.Hysteroscopic surgery was performed after 2 cycles,and the artificial cycle treatment was continued for 2 to 3 courses.Control group only received artificial cycle treatment after surgery.Two groups of patients underwent hysteroscopic surgery after menstruation was cleared,and patients with amenorrhea underwent elective surgery.The clinical effect of the two groups was compared.Results Before intervention,there was no significant difference in serum metalloproteinase-9(MMP-9),transforming growth factorβ:(TGF-β)and vascular endothelial growth factor(VEGF)levels between 2 groups(P>0.05).3 months after intervention,compared with the control group,the serum levels of MMP-9,TGF-βand VEGF in the study group were decreased,and the difference was statistically significant(P<0.05).Before intervention,there was no significant difference in endometrial thickness,resistance index(RI)and pulse index(PI)between 2 groups(P>0.05).At 3 months after the intervention,compared with the control group,the endometrium of the study group was thicker,and the PI and RI values were significantly reduced,with statistical significance(P<0.05).The improvement rate of menstruation after intervention was 92.86%in the study group and 71.43%in the control group.The improvement rate of menstruation in the study group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).Compared with the control group,the incidence of intrauterine adhesions in the study group was lower after intervention,and the difference was statistically significant(P<0.05).Conclusion Preoperative estradiol valerate pretreatment combined with hysteroscopic treatment for intrauterine adhesion after abortion has a definite effect,which can improve the blood flow parameters of patients,increase endometrial thickness,improve menstruation,reduce the incidence of intrauterine readhesion,which is worthy of clinical promotion and application.