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目的探讨重度宫腔粘连(intrauterine adhesion,IUA)在宫腔镜下粘连分离术后注水球囊、宫内节育器(Intrauterine Device,IUD)联合不同剂量雌激素预防再粘连的临床效果。方法选取2008年1月至2013年1月在遵化市人民医院宫腔镜检查确诊为重度IUA行腹腔镜监视下宫腔镜下IUA分离术后开注水球囊、放置“O”型IUD 1枚的60例患者,根据术后应用雌激素方法不同分为研究组及对照组:研究组30例,术后第1 d连续服用戊酸雌二醇3 mg,3次/d,3个月,后10 d加黄体酮胶囊200 mg,1次/d,10 d后撤退出血;对照组30例,术后第1 d服用戊酸雌二醇2 mg,3次/d,21 d,后10 d加黄体酮胶囊200 mg,1次/d,10 d后撤退出血,3个周期。术后3个月复查IUA情况及宫腔镜检查、取IUD,轻度膜状粘连者以检查镜予分开。术后3月观察月经情况。分别在用药前及用药后3个月抽取患者清晨空腹血样,检测凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)及纤维蛋白原(fibrinogen,Fib)、丙氨酸转氨酶(Alanine transaminase,ALT)、谷草转氨酶(Aspertate transferase,AST)、甘油三脂(triglyceride,TG)及总胆固醇(total cholesterol,TC)指标。结果研究组宫腔镜手术后宫腔再粘连3例(10%);对照组宫腔再粘连5例(16.67%),两组比较差异无统计学意义(P>0.05)。月经改善研究组29例(96.67%);对照组22例(73.3%),差异有统计学意义(P<0.05)。治疗前及治疗后3月两组患者PT、APTT、TT、Fib、ALT、AST、TG及TC指标比较差异均无统计学意义(P>0.05)。结论重度IUA术后注水球囊、IUD联合大剂量雌激素(3 mg)连续口服能明显改善月经情况,无术后并发症,安全、有效。
Objective To investigate the clinical effect of intrauterine adhesion (IUA) combined with intrauterine device (IUD) combined with different doses of estrogen on the prevention of reunion after hysteroscopic adhesion separation. Methods From January 2008 to January 2013 in Zunhua People’s Hospital, hysteroscopy diagnosed as severe IUA under laparoscopy IUA hysteroscopic open water balloon, placed “O ” type Sixty patients with IUD 1 were divided into study group and control group according to the different methods of postoperative estrogen therapy. The study group consisted of 30 patients. The patients were treated with 3 mg estradiol valerate 3 mg once daily for 3 d Month, 10 days after the addition of progesterone capsules 200 mg, 1 / d, 10 days after withdrawal bleeding; control group of 30 patients, 1 d after taking estradiol valerate 2 mg, 3 times / d, 21 d , After 10 d plus progesterone capsules 200 mg, 1 / d, 10 days after withdrawal bleeding, 3 cycles. 3 months after IUA review of the situation and hysteroscopy, IUD, mild membranous adhesions to check the mirror to be separated. After 3 months to observe the menstrual situation. The fasting blood samples were taken from the patients before treatment and 3 months after the administration. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT ), Fibrinogen (Fib), alanine transaminase (ALT), aspartate transaminase (AST), triglyceride (TG) and total cholesterol (TC) Results There were 3 cases (10%) of uterine cavity adhesions after hysteroscopic surgery in the study group. There were 5 cases (16.67%) of uterine cavity adhesions in the control group. There was no significant difference between the two groups (P> 0.05). There were 29 cases (96.67%) in the study group and 22 cases (73.3%) in the control group, the difference was statistically significant (P <0.05). There was no significant difference in PT, APTT, TT, Fib, ALT, AST, TG and TC between the two groups before and after treatment (P> 0.05). Conclusion Severe IUA postoperative injection balloon, IUD combined with high dose estrogen (3 mg) continuous oral administration can significantly improve menstrual conditions, no postoperative complications, safe and effective.