血中不同浓度雌二醇及两种不同屏障治疗宫腔粘连术后的应用研究

摘要

Objective To observe the efficacy of the blood concentrations of estradiol and different ancillary treatments after transcervical resection of adhesions(TCRA) with intrauterine adhesion(IUA). Methods A total of 42 patients hospitalized in our hospital during 2014.5~2015.6 diagnosed as IUA were enrolled in this study. They were randomly divided into 3 groups,postoperative use of inserting a balloon and oral estradiol valerate (E2V) 3 mg (Group A), intrauterine device(IUD) encapsulated by absorbable adhesion barrier (polylactic acid membrane) and oral E2V 3 mg (Group B),IUD encapsulated by polylactic acid membrane and vaginal 17-beta estradiol 2 mg (Group C). Side effects, blood concentrations of estradiol and herapeutic effects were observed. Results There was no obvious side effect in 3 groups after operation. The concentrations of estradiol in serum of C group were significantly higher than those in A group and B group,Difference was statistically significant (P<0.05).A comparison of three groups of patients with menstrual improvement,Difference was statistically significant (P<0.05).Menstrual improvement rate of C group, B group, A group.Three groups of patients with postoperative prognosis score, improve the score (preoperative and postoperative) group comparison,The difference was statistically significant (P<0.05),C group, B group, A group,C group was compared with A group and B group,The difference was statistically significant (P<0.05);Compared with the A group, the B group,The difference was not statistically significant (P>0.05);Three groups of patients before and after treatment to improve the score,The difference was statistically significant (P<0.05). Comparison of the three groups of patients with effective rate,The difference was statistically significant (P<0.05),The effective rate of C was higher than that of B group and A group. Conclusion The clinical effect of comprehensive treatment method of TCRA combined with IUD of polylactic acid membrane and vaginal high dose of estrogen is significantly better than other methods.%目的：观察血雌二醇不同浓度及不同屏障治疗对宫腔粘连分离术（TCRA）后结局的影响。方法选取2014年5月～2015年6月在无锡市妇幼保健院住院治疗的宫腔粘连（IUA）患者42例进行TCRA后随机分为A、B、C组，分别采取3种不同方法预防宫腔粘连，比较A组（球囊+口服戊酸雌二醇3 mg）、B组（宫腔内放置防粘连膜包裹的金属圆环+口服戊酸雌二醇3 mg）、C组（置防粘连膜包裹的金属圆环+阴道用17-β雌二醇2 mg）的副反应、血雌二醇浓度及疗效。结果术后三组患者均无明显副反应。术后血雌二醇浓度C组明显高于A组、B组，差异有统计学差异（P＜0.05）。三组患者间月经改善情况比较，差异有统计学意义（P＜0.05），月经改善率C组＞B组＞A组。三组患者术后预后评分、评分改善情况（术前-术后）组间比较，差异均有统计学意义（P＜0.05），评分改善C组＞B组＞A组，C组与A组、B组相比，差异有统计学意义（P＜0.05）；B组与A组相比，差异无统计学意义（P＞0.05）；三组患者治疗前后评分改善对比，差异均有统计学意义（P＜0.05）。三组患者治疗有效率比较，差异有统计学意义（P＜0.05），C组治疗有效率高于B组及A组。结论血中高浓度雌二醇及防粘膜包裹节育环联合使用预防宫腔粘连术后复发疗效佳。