雌二醇片/雌二醇地屈孕酮片预防稽留流产刮宫术后宫腔粘连的临床疗效

Efficacy of using estradiol/estradiol and dydrogesterone tablets for preventing intrauterine adhesions after uterine curettage for missed abortion

目的观察稽留流产刮宫术后使用雌二醇片/雌二醇地屈孕酮片(商品名:芬吗通)预防宫腔粘连的疗效。方法选择2022年6月~2023年6月稽留流产刮宫术后患者180例,随机分为芬吗通组和对照组,每组各90例。两组均全程超声监护下行无痛刮宫术,术毕所有患者服用抗生素预防感染。芬吗通组患者在手术当晚20点开始服用芬吗通,对照组术后不予以其他特殊处理。比较两组患者术后阴道流血持续时间、术后2周子宫内膜厚度、月经恢复时间、手术前后月经量变化、宫腔粘连率。结果两组患者年龄、胎次、流产史、闭经时间差异无统计学意义(P>0.05)。与对照组相比,芬吗通组术后阴道出血持续时间显著缩短[(5.02±2.57)d vs.(7.96±4.64)d,P<0.01];术后2周子宫内膜厚度显著增加[(6.95±3.61)mm vs.(4.96±2.11)mm,P<0.01];恢复月经所需时间更少[(32.02±7.99)d vs.(36.51±8.87)d,P<0.01];术后月经量少于平时月经量的女性更少(34.44%vs.40.00%,P=0.043);术后3个月宫腔粘连发生率显著低于对照组(4.44%vs.13.33%,P=0.036)。结论稽留流产刮宫术后应用芬吗通能有效促进子宫内膜修复,预防宫腔粘连。

Objective To observe the effect of estradiol/estradiol and dydrogesterone tablets(Trade name:Fematon)for preventing intrauterine adhesions after uterine curettage for missed abortion.Methods A total of 180 patients with missed abortion after uterine curettage from June 2022 to June 2023 were randomly divided into Fematon group and control group,with 90 cases in each group.Both groups underwent painless uterine curettage under ultrasound guidance,and all patients took antibiotics to prevent infection after surgery.The Fematon group received oral Fematon to prevent intrauterine adhesions at 20 o'clock on the night of surgery,while the control group received no intervention.The duration of postoperative vaginal bleeding,endometrial thickness 2 weeks after surgery,menstrual recovery time,changes in menstrual volume before and after surgery,incidence of intrauterine adhesions were compared between the two groups.Results There were no significant differences in age,parity,abortion history and amenorrhea duration between the two groups(P>0.05).Compared to the control group,the duration of postoperative vaginal bleeding was shorter in the Fematon group[(5.02±2.57)d vs.(7.96±4.64)d,P<0.01].The endometrial thickness increased after two weeks of surgery in the Fematon group[(6.95±3.61)mm vs.(4.96±2.11)mm,P<0.01],and the time to resumption of menstruation was shorter[(32.02±7.99)d vs(.36.51±8.87)d,P<0.01],fewer women menstruated less than usual after surgery(34.44%vs.40.00%,P=0.043).The incidence of intrauterine adhesions after three months of surgery was lower(4.44%vs.13.33%,P=0.036).Conclusion The use of Fematon after uterine curettage for missed abortion can effectively promote endometrial repair and prevent intrauterine adhesions.