不同剂量戊酸雌二醇用于子宫纵隔切除术术后预防宫腔粘连∗

摘要

Objective To explore the effect of different dosages of progynova in preventing intrauterine adhesions after transcervical resection of septum ( TCRS) under laparoscope. Methods Clinical data of 213 TCRS patients under laparoscope were retrospectively analyzed, and these cases were divided into four groups according to the dosages of progynova. Except for group A (n=26), group B, C, D were given 4,6,8 mg.d-1 of progynova.Endometrial thickness, menstrual blood volume, incidence rates of residual septal and intrauterine adhesions, rate of adverse effect, pregnancy rate after operation and rate of spontaneous abortion were compared among the four groups. Results The incidence rate of residual septal in group A, B, C, D was 11.5%, 6.9%, 6.0% and 6.3%, respectively.Incidence rate of intrauterine adhesions after operation was 46.2%, 12.5%, 9.0% and 4.2%, respectively.The pregnancy rate in group A, B, C and D was 30.8%, 59.7%, 58.2% and 60.4%, respectively. There were significant differences between group A and the other groups(all P<0.05).The high dose of progynova(8 mg.d-1) significantly increased endometrial thickness ( P<0. 05 ) and menstrual blood volume ( P<0. 05 ) . But the incidence rates of gastrointestinal tract reaction, hepatic damage and vaginal spotting in the high dose group of progynova increased obviously( P<0.05) . Conclusion Progynova is a safe and effective drug in preventing intrauterine adhesions after TCRS. It can effectively prevent intrauterine adhesions, increase pregnancy rate and improve pregnant outcome.%目的：探讨不同剂量戊酸雌二醇预防腹腔镜监视子宫纵隔切除术( TCRS)术后宫腔粘连的效果。方法回顾性分析213例腹腔镜监视下TCRS患者的临床资料,根据用药方法分为4组A组26例：未使用戊酸雌二醇；B组72例：口服戊酸雌二醇4 mg.d－1；C组67例：口服戊酸雌二醇6 mg.d－1；D组48例：口服戊酸雌二醇8 mg.d－1,对比不同剂量给药患者。子宫内膜厚度、月经量、残余纵隔及宫腔粘连发生率、不良反应发生率、术后妊振率及自然流产率等情况。结果 A,B,C,D组患者残余纵隔发生率分别为11.5％,6.9％,6.0％,6.3％,宫腔粘连发生率分别为46.2％,12.5％,9.0％,4.2％；B,C,D组较A组明显降低( P<0.05),B,C,D组术后妊娠率分别为59.7％,58.2％,60.4％,较A组(30.8％)明显提高(P<0.05)；D组患者B超监测子宫内膜厚度较厚(P<0.05),月经量明显增多(P<0.05)；但胃肠道反应、肝功能异常发生率、阴道点滴出血发生率明显增高( P<0.05)。结论戊酸雌二醇用于子宫纵隔切除术术后防止宫腔粘连是安全有效的药物选择,能有效防止宫腔粘连形成、提高妊振率及改善妊振结局。