雌、孕激素治疗人工流产后吸宫不全的研究

摘要

目的：对使用雌、孕激素治疗人工流产后吸宫不全的临床疗效进行初步探讨。方法选择人工流产术后诊断为吸宫不全患者160例，随机分为两组，研究组80例用雌、孕激素治疗；对照组80例行清宫术。比较两组腹痛、阴道流血情况、患者依从性、血清β-hCG水平及宫腔内情况。研究组治疗后当血清β-hCG水平≥300 ng／mL，或阴道B型超声下宫腔内不均质光团最大直径≥1 cm时，则进行二次清宫，比较清宫率及病理发现绒毛情况。结果（1）阴道流血：研究组11例（13.75％），对照组1例（1.25％），（P＝0.003，χ2＝9.009）。（2）研究组80例愿意接受治疗，对照组5例愿意接受治疗，显著多于对照组（ P＝0.000，χ2＝141.176）。（3）研究组治疗后血清β-hCG水平由治疗前的（197.1＋63.5） ng／mL下降至（23.5＋9.8） ng／mL，与治疗前比较差异有统计学意义（P＝0.000， t＝1.43），与对照组比较差异无统计学意义（P＝0.433， t＝－1.75）。（4）阴道B型超声下子宫内不均质光团直径由治疗前的（3.0＋2.0） cm 缩小至（0.22＋0.52） cm，与治疗前比较差异有统计学意义（P＝0.034， t＝0.82）；与对照组比较差异无统计学意义（P＝0.384， t＝1.46）。（5）研究组治疗后8例需要清宫，显著少于对照组（P＝0.000，χ2＝130.909）。（6）绒毛检出率为62.5％，显著高于对照组（31.2％）（ P＝0.041，χ2＝4.170）。结论使用雌、孕激素治疗人工流产后吸宫不全可促进子宫内膜修复，减少二次清宫。%Objective To evaluate the clinical effect of estrogen and progestogen intreatmentofincompleteabortionafterinducedabortion.Methods 160patients complicated with suspected incomplete abortion after induced abortion within pregnant 10 weeks were analyzed.All patients were randomly divided into two groups study group(n=80)using etrogen and progestogen and control group(n =80)taking dilation and curettage(D&C).Abdominal pain bleeding acceptability β-hCG level transvaginal ultrasound were evaluated.When β-hCG level was ≥300ng/mL or the diameter of heterogeneous mass manifesting from transvaginal ultrasound were over 1 cm the patients would undergo D&C procedure after the treatment in study group.The rates of D&C and placental villi found were compared between two groups. Results There were no abdominal pain after the treatment in two groups.11 patients were still bleeding after the treatment in study group.There were statistic more than 1 patient in control group(P=0 .003 χ2 =9 .009).80 patients all accepted medicine treatment in the study group were statistic more than 5 patients in control group(P=0.000 χ2 =141.176). Serumβ-hCG level after the treatment in study group were statistic lower than which before the treatment from(197.1+63.5)ng/mL to(23.5+9.8)ng/mL(P=0.000 t=1 .43) and there were no statistic difference compared with control group(P=0 .433 t =-1 .75).The diameters of heterogeneous mass manifesting from transvaginal ultrasound after the treatment in study group were reducted statistically than which before the treatment from (3.0 +2.0)cm to (0.22 +0.52)cm(P=0.034 t=0.82).and there were no statistic difference compared with control group(P=0.384 t=1.46). 8 patients were undergoing D&C procedure after the treatment in study group which were statistic lower than 80 patients in control group (P=0 .000).The ratio of placental villi found by pathological exam in study group were 5(62 .5%)which were statistic increased than control group 25(31.2%)(P=0.041 χ2 =4.170). Conlusions The treatment of estrogen and progestogen could be applied in treating incomplete abortion first for rehabilitating endometrium after induced abortion.