应用不同剂量雌激素对宫腔镜宫腔粘连松解术后粘连复发和生育结局的影响

Effect of estrogen on recurrence of adhesions and reproductive outcomes after hysteroscopic adhesion-lysis

目的探讨应用不同剂量雌激素对宫腔镜宫腔粘连松解术后粘连复发和生育结局的影响。方法回顾性选取2022年1月至2023年7月西北妇女儿童医院妇科内分泌宫腔粘连患者80例,依据应用雌激素剂量不同分为大剂量组、小剂量组两组,每组各40例。宫腔镜宫腔粘连松解术后,大剂量组采用2 mg戊酸雌二醇片+10 mg醋酸甲羟孕酮片,小剂量组采用1 mg戊酸雌二醇片+10 mg醋酸甲羟孕酮片。比较两组患者的宫腔粘连程度、子宫内膜厚度、子宫体积、月经量、行经时间、血管内皮生长因子水平、月经模式、临床疗效、粘连复发情况、生育结局及不良反应发生情况。结果大剂量组患者的月经模式评分、粘连类型评分、粘连范围评分、AFS总分均明显低于小剂量组,差异均有统计学意义(P<0.05)。大剂量组患者的子宫内膜厚度、子宫体积、月经量、血管内皮生长因子水平均明显高于小剂量组,行经时间长于小剂量组,差异均有统计学意义(P<0.05)。大剂量组患者的月经正常率为25.00%,高于小剂量组(10.00%),月经减少率、闭经率分别为75.00%、0,均低于小剂量组(87.50%、2.50%),差异均有统计学意义(P<0.05)。大剂量组患者的总有效率为97.50%,明显高于小剂量组(80.00%),粘连复发率为2.50%,明显低于小剂量组(32.50%),差异均有统计学意义(P<0.05)。大剂量组患者的活产率、总妊娠率、自然妊娠率分别为47.50%、50.00%、30.00%,均明显高于小剂量组(15.00%、25.00%、10.00%),差异均有统计学意义(P<0.05)。两组患者的不良反应发生率(15.00%vs.12.50%)比较,差异无统计学意义(P>0.05)。结论大剂量雌激素应用于宫腔镜宫腔粘连松解术后较小剂量雌激素临床疗效更为显著,更能减轻患者宫腔粘连程度,能改善月经量及月经周期,能降低患者的粘连复发率,改善患者的生育结局。

Objective To investigate the effects of different doses of estrogen on the recurrence of adhesions and reproductive outcomes after hysteroscopic adhesions release.Methods From January 2022 to July 2023,80 patients with gynecological endocrine intrauterine adhesions in Northwest Women and Children's Hospital were retrospectively selected.According to the different doses of estrogen,they were divided into two groups:the high-dose group and the low-dose group,with 40 cases in each group.After hysteroscopic intrauterine adhesion lysis,the high-dose group was treated with 2 mg estradiol valerate tablets+10 mg medroxyprogesterone acetate tablets,and the low-dose group was treated with 1 mg estradiol valerate tablets+10 mg medroxyprogesterone acetate tablets.The degree of uterine adhesions,endometrial thickness,uterine volume,menstrual volume,duration of menstruation,vascular endothelial growth factor level,menstrual pattern,clinical efficacy,recurrence of adhesions,reproductive outcomes and adverse reactions were statistically analyzed in the two groups.Results The menstrual pattern score,adhesion type score,adhesion range score and AFS total score of the high-dose group were significantly lower than those of the low-dose group,and the differences were statistically significant(P<0.05).The endometrial thickness,uterine volume,menstrual volume and vascular endothelial growth factor level in the high-dose group were significantly higher than those in the low-dose group,and the menstrual time was longer than that in the low-dose group,the differences were statistically significant(P<0.05).The normal rate of menstruation in the high-dose group was 25.00%,which was higher than that in the low-dose group(10.00%),the menstrual reduction rate and amenorrhea rate were 75.00%and 0,respectively,which were lower than those in the low-dose group(87.50%,2.50%),the differences were statistically significant(P<0.05).The total effective rate of high-dose group was 97.50%,which was higher than that of low-dose group(80.00%),and the recurrence rate of adhesion was 2.50%,which was lower than that of low-dose group(32.50%),the differences were statistically significant(P<0.05).The live birth rate,total pregnancy rate and natural pregnancy rate in high-dose group were 47.50%,50.00%,30.00%,respectively,which were higher than those in low-dose group(15.00%,25.00%,10.00%),the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The clinical efficacy of high-dose estrogen after hysteroscopic intrauterine adhesions is more significant than that of low-dose estrogen.It can reduce the degree of intrauterine adhesions,improve menstrual volume and menstrual cycle,reduce the recurrence rate of adhesions,and improve the fertility outcome of patients.It is worth promoting.