宫腔镜下宫腔粘连切除术辅助戊酸雌二醇治疗人工流产术后粘连39例患者疗效观察

摘要

目的 探究宫腔镜下宫腔粘连切除术(TCRA)辅助戊酸雌二醇治疗人工流产术后宫腔粘连(IUA)的临床效果.方法 抽取2014年4月至2015年5月本院收治的78例IUA患者,通过随机数字表法分为对照组与研究组,各39例.对照组仅行TCRA治疗,研究组采用TCRA+戊酸雌二醇治疗,6个月后随访.统计对比两组临床疗效、宫腔再粘连及受孕情况,并分析治疗前后两组肝功能[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)]与血脂[总胆固醇(TC)、三酰甘油(TG)]、子宫内膜厚度变化情况.结果 研究组治疗有效率(97.44％)高于对照组(79.48％),差异有统计学意义(P＜0.05).研究组宫腔再粘连发生率(15.38％)低于对照组(35.90％),受孕率(33.33％)高于对照组(12.52％),差异有统计学意义(均P＜ 0.05).两组治疗前后AST、ALT、TC、TG水平对比,差异均无统计学意义(均P＞ 0.05).治疗前,两组子宫内膜厚度对比,差异无统计学意义(P＞0.05);治疗后,两组子宫内膜厚度均较治疗前增加,但研究组优于对照组,差异有统计学意义(均P＜ 0.05).结论 宫腔镜下宫腔粘连切除术辅助戊酸雌二醇治疗人工流产术后宫腔粘连效果显著,可促使月经恢复,增加子宫内膜厚度,提高治疗效果及受孕率,降低宫腔粘连复发率,且不会对患者肝功能及血脂水平造成不利影响,安全性较高.%Objective To explore the clinical effect of transcervical rescection of adhesions (TCRA) assisted by estradiol valerate for induced abortion intrauterine adhesion (IUA).Methods 78 IUA patients treated at our hospital from April,2014 to May,2015 were divided into a control group and a study group using random number table,39 cases for each group.The control group was treated with only TCRA and the study group with TCRA and estradiol valerate.Both group were followed up after 6 months.The clinical curative effect,recurrence of uterine cavity adhesion,and pregnancy were compared between these two groups.The liver function [aspartate aminotransferase (AST),alanine aminotransferase (ALT)],serum total cholesterol (TC),triglycerides (TG),and the changes of endometrial thickness before and after the treatment in two groups were analyzed.Results The clinical curative effect rate was higher in the study group than in the control group (97.44％ vs.79.48％),with a statistical difference (P ＜ 0.05).The recurrence rate of intrauterine adhesion was lower and the pregnancy rate was higher in the study group than in the control group (15.38％ vs.35.90％ and 33.33％ vs.12.52％),with statistical differences (P ＜ 0.05).There were no statistical differences in the levels ofAST,ALT,TC,and TG before and after the treatment between these two groups (P ＞ 0.05).There was no statistical difference in endometrial thickness between these two groups before the treatment (P ＞ 0.05).The endometrial thickness was thicker after than before the treatment in both groups and was better in the study group than in the control group after the treatment,with statistical differences (P ＜ 0.05).Conclusions Transcervical rescection of adhesions assisted by estradiol valerate for IUA is significant effective,can promote the recovery of menstruation,increase the endometrial thickness and pregnancy rate,improve the therapeutic effect,and reduce the recurrence rate of intrauterine adhesions,and does not cause adverse effects on liver function and blood lipid levels in patients with high safety.