本文關(guān)鍵詞：陰道用雌二醇預(yù)防中重度宮腔粘連術(shù)后復(fù)發(fā)的效果研究　出處：《中山大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 宮腔粘連 Asherman綜合征 雌二醇 宮腔粘連松解術(shù)

【摘要】：研究背景宮腔粘連(intrauterine adhesions,IUA),又叫Asherman綜合征,是因子宮內(nèi)膜基底層損傷性后病理性修復(fù)所形成的宮腔或?qū)m頸局部或全部粘連,從而影響患者月經(jīng)及生育功能的一種常見臨床疾病,多由宮腔操作及子宮內(nèi)膜感染等引起,臨床可表現(xiàn)為月經(jīng)量減少、閉經(jīng)、周期性腹痛、不孕、習(xí)慣性流產(chǎn)等。宮腔鏡檢查是IUA診斷的金標(biāo)準(zhǔn),超聲及子宮輸卵管造影等可輔助診斷。根據(jù)美國生育協(xié)會1988年制定評分標(biāo)準(zhǔn),結(jié)合患者月經(jīng)及粘連情況可將IUA分為輕、中至重度粘連,可提示預(yù)后和指導(dǎo)治療。宮腔鏡下粘連分離術(shù)(transcervical resection of adhesions,TCRA)是目前治療宮腔粘連的基本方法,如何減少復(fù)發(fā)和改善預(yù)后是難點(diǎn)。目前,臨床上常用的輔助措施包括宮腔放置物理屏障及生物膠體,口服大劑量雌激素和生物移植等。中、重度宮腔粘連術(shù)后復(fù)發(fā)率為20.0%~78.9%,治療效果仍不能令人滿意。陰道用雌二醇在輔助生育技術(shù)中顯示出較口服途徑更好的促進(jìn)子宮內(nèi)膜增生的作用效果。本研究擬在TCRA聯(lián)合宮腔放置球囊子宮支架治療中、重度IUA的基礎(chǔ)上,通過比較術(shù)后分別予口服及陰道用17β-雌二醇的人工周期預(yù)防IUA術(shù)后復(fù)發(fā)粘連的效果,從而探討陰道用17β-雌二醇在預(yù)防中重度宮腔粘連分離術(shù)后復(fù)發(fā)的應(yīng)用價(jià)值。研究目的1.比較TCRA術(shù)兩種雌激素治療方法預(yù)防中、重度IUA復(fù)發(fā)的效果,探討陰道用雌二醇的有效性及安全性。2.兩種用藥途徑相應(yīng)血清雌二醇(E2)水平及治療過程中子宮內(nèi)膜厚度的情況。3.中、重度IUA患者治療后血清雌激二醇水平與子宮內(nèi)膜厚度、療效的關(guān)系。研究對象與方法收集我院2014年03月01日~2014年12月31日宮腔鏡下確診為中、重度宮腔粘連患者共50例,將患者隨機(jī)分成研究組及對照組。所有患者均予行B超引導(dǎo)下TCRA術(shù)成功重建宮腔形態(tài),術(shù)中予生物膠體沖洗宮腔,在抗炎治療的同時(shí)放置球囊子宮支架7天后取出。術(shù)后,研究組給予17β-雌二醇1mg/天陰道給藥的方案行人工周期治療,對照組予17β-雌二醇8mg/天口服給藥的方案行人工周期;兩組患者用藥3周,第三周均加地屈孕酮10mg BID口服,停藥1周,共治療3個(gè)人工周期。定期隨訪月經(jīng)時(shí)間與經(jīng)量、血清雌二醇水平、子宮內(nèi)膜情況及用藥不良反應(yīng)。治療結(jié)束后復(fù)查肝腎功能及凝血等評估藥物副反應(yīng)情況,必要時(shí)予對癥處理。復(fù)查宮腔鏡評估宮腔形態(tài)恢復(fù)情況,若有粘連復(fù)發(fā),予鈍性分離,粘連嚴(yán)重?zé)o法分離者則予入院二次手術(shù)治療。收集相關(guān)臨床資料,進(jìn)行統(tǒng)計(jì)分析。結(jié)果1.研究組與對照組月經(jīng)量改善率(68.0%和80.0%)、宮腔恢復(fù)正常率(64.0%和72.0%)、宮腔改善率(100.0%和96.0%)、二次手術(shù)率(12.0%和8.0%)、妊娠率(均為26.7%)以及術(shù)后AFS評分差值(中位數(shù)均為8.0分)比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。2.研究組平均血清E2水平為(742.30±435.58)pg/ml,對照組患者為(253.28±131.31)pg/ml,差異具有統(tǒng)計(jì)學(xué)意義(P0.001);每個(gè)人工周期內(nèi)研究組平均子宮內(nèi)膜厚度在均高于對照組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.患者血清E2水平與子宮內(nèi)膜增長厚度及AFS評分差值的相關(guān)性均無統(tǒng)計(jì)學(xué)意義(P0.05),按血清E2不同水平[500pg/ml、(500~999)pg/ml和≥1000pg/ml]將患者分三組,比較第三個(gè)人工周期平均內(nèi)膜厚度、子宮內(nèi)膜增長厚度及AFS評分差值,各組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.研究組與對照組不良反應(yīng)率分別為28.0%和32.0%,差異無統(tǒng)計(jì)學(xué)意義(P0.05),常見癥狀有外陰陰道酵母菌性陰道炎(12.0%和20.0%)、消化道不適(8.0%和0.0%)和乳房脹痛(0.0%和4.0%),僅陰道炎需要藥物治療,其余癥狀均可自行緩解。兩組患者肝腎及凝血功能、血脂在術(shù)前、術(shù)后與術(shù)后變化值無統(tǒng)計(jì)學(xué)差異(P0.05)。陰道雌二醇治療對凝血、血脂及肝腎功能不造成明顯不良影響。結(jié)論1.陰道和口服雌激素在預(yù)防中、重度宮腔粘連術(shù)后復(fù)發(fā)的療效及不良反應(yīng)結(jié)果相當(dāng),陰道用藥更為經(jīng)濟(jì)、方便。2.跟口服雌激素相比,陰道用藥血清E2水平更高,早期子宮內(nèi)膜增長更快,但兩種用藥治療3個(gè)周期后達(dá)到的子宮內(nèi)膜厚度相當(dāng)。3.當(dāng)血清E2高于500pg/ml水平后,增加E2水平并不能進(jìn)一步增加子宮內(nèi)膜厚度及提高療效。
[Abstract]:The research background of intrauterine adhesions (intrauterine adhesions, IUA), also called Asherman syndrome, is the basal layer of the endometrium pathological injury after repair of uterine cervical or partial or total adhesion, thus affecting a common clinical disease, menstruation and reproductive function of patients, caused by uterine cavity operation and uterine infection, clinical manifestations of oligomenorrhea, amenorrhea, periodic abdominal pain, infertility, habitual abortion. Hysteroscopy is the gold standard for the diagnosis of IUA, ultrasound and hysterosalpingography can assist the diagnosis. According to the American Fertility Association in 1988 to develop a standard for evaluation, combined with menstruation and adhesion can be IUA is divided into light, moderate to severe adhesion, prognosis and guiding the treatment. Hysteroscopic adhesiotomy (transcervical resection of adhesions, TCRA) is a basic method for treatment of intrauterine adhesions at present, how to reduce the complex And improve the prognosis is difficult. At present, the common clinical auxiliary measures including uterine cavity placed a physical barrier and Biocolloid, high-dose oral estrogen and biological transplantation. In severe intrauterine adhesions after operation, the recurrence rate was 20.0%~78.9%, the treatment effect is still not satisfactory. The vaginal estradiol in assisted reproductive technology display the oral route to better promote endometrial hyperplasia effect. This study was placed uterine stent in TCRA combined with uterine cavity in the treatment of severe IUA, based on the comparison after operation were given oral and vaginal artificial cycle 17 estradiol to prevent recurrence after IUA adhesion effect, so as to explore the vagina with 17 beta estradiol in the prevention of severe intrauterine adhesions after relapse prevention application. Objective: 1. TCRA comparison of two kinds of estrogen therapy, the effect of severe IUA recurrence, discussion The vagina with the efficacy and safety of.2. estradiol two ways of using the corresponding serum estradiol (E2) level and endometrial thickness in the treatment of.3. in severe IUA patients, serum estrogen estrogen level and endometrial thickness, curative effect. The relationship between the research objects and methods in our hospital from 2014 03 month 01 December 31st ~2014 hysteroscopy diagnosed in severe intrauterine adhesions in patients with a total of 50 cases, the patients were randomly divided into study group and control group. All patients were treated by ultrasound guided TCRA surgery successful reconstruction of uterine cavity shape, intraoperative to Biocolloid flushing the uterine cavity, and uterine balloon placement stents in anti-inflammatory therapy take out after 7 days. After the operation, the study group was given 17 estradiol 1mg/ days vaginal delivery scheme for artificial cycle therapy, control group was treated with 17 beta estradiol 8mg/ day oral administration scheme for artificial cycle; two groups of patients after treatment for 3 weeks, third Week plus dydrogestrone 10mg BID orally, stopping for 1 weeks, were treated with 3 artificial cycle. Regular follow-up time and the amount of menstruation, serum estradiol level, endometrium and adverse drug reaction. After the treatment of the adverse drug reaction of liver and kidney function and coagulation evaluation, if necessary, symptomatic treatment review assessment. Hysteroscopy uterine cavity shape recovery, if adhesion recurrence, to blunt separation, severe adhesion can not be separated is to two times to the hospital surgery. Collect clinical data for statistical analysis. Results of the 1. study group and control group menstrual improvement rate (68% and 80%), to restore normal uterine cavity the rate (64% and 72%), intrauterine improvement rate (100% and 96%), the two operation rate (12% and 8%), the pregnancy rate (26.7%) and postoperative AFS score (median of 8) were no statistically significant difference (P0.05) of.2. group mean serum E2 The flat is (742.30 + 435.58) pg/ml, the control group was (253.28 + 131.31) pg/ml, the difference was statistically significant (P0.001); the mean endometrial thickness in the study group were higher than the control group of each artificial cycle, but the difference was not statistically significant (P0.05) correlation between.3. and serum E2 level in patients with endometrial thickness and growth AFS scores were not statistically significant (P0.05, [500pg/ml) according to the different levels of serum E2, pg/ml and 1000pg/ml] (500~999) were divided into three groups, compared third artificial cycle average endometrial thickness, endometrial thickness and growth AFS score difference, no statistically significant difference between groups (P0.05) of.4. group and control the adverse reaction rates were 28% and 32%, the difference was not statistically significant (P0.05), common symptoms of vulvovaginal yeast vaginitis (12% and 20%), gastrointestinal discomfort (8% and 0%) and breast pain (0% and 4 %), only vaginitis need drug treatment, the symptom relieved by itself. Two groups of liver and kidney and blood coagulation function of patients with blood lipid in preoperative, postoperative and postoperative changes of value had no significant difference (P0.05). The vaginal estradiol treatment on blood coagulation, blood lipid and renal function did not cause significant adverse effects. Conclusion 1. vaginal and oral estrogen in the prevention of severe intrauterine adhesions postoperative recurrence of curative effect and adverse reaction results, vaginal medication is more economical and convenient.2. compared with oral estrogen vaginal medication serum E2 levels higher, early endometrial growth faster, but to two kinds of medication after 3 cycles of treatment of endometrial thickness is.3. when the serum E2 level was higher than that of 500pg/ml, increased E2 levels did not further increase the endometrial thickness and improve the curative effect.

【學(xué)位授予單位】：中山大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R713.4

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郭寶艷;中西醫(yī)結(jié)合治療宮腔粘連58例[J];中國民間療法;2004年06期

2 王春霞;宮腔鏡診治68例宮腔粘連的效果分析[J];中國婦幼保健;2005年11期

3 彭鳳云,李桂林,劉曉慧,張法麗,沙小龍;宮腔鏡診斷宮腔粘連180例臨床分析[J];現(xiàn)代診斷與治療;2005年04期

4 唐旭,葛春曉;宮腔粘連診治的研究進(jìn)展[J];中國微創(chuàng)外科雜志;2005年10期

5 李夏,王東輝,田喜萍,宋春枝,田改環(huán);電視宮腔鏡對宮腔粘連的診治[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2005年05期

6 陳小影;;聯(lián)合診治宮腔粘連23例臨床分析[J];中國內(nèi)鏡雜志;2006年02期

7 段寶山;;宮腔粘連的診斷及誤診分析[J];山西醫(yī)藥雜志;2006年04期

8 黎文清;黃向芳;;自控顯示儀診治宮腔粘連159例臨床療效分析[J];醫(yī)藥世界;2006年06期

9 嚴(yán)德文;許麗娜;;宮腔鏡下宮腔粘連分離40例近期療效評價(jià)[J];中國內(nèi)鏡雜志;2006年10期

10 皮回春;祝文峰;張金娥;毛松川;;宮腔鏡在診治宮腔粘連中的應(yīng)用[J];華夏醫(yī)學(xué);2007年01期

相關(guān)會議論文 前10條

1 劉玉環(huán);夏恩蘭;趙玉婷;宋冬梅;周鳳瓊;;大劑量雌激素改善中重度宮腔粘連預(yù)后的研究[A];中華醫(yī)學(xué)會第十次全國婦產(chǎn)科學(xué)術(shù)會議婦科內(nèi)鏡會場（婦科內(nèi)鏡學(xué)組）論文匯編[C];2012年

2 上官雪軍;楊梅麗;張琴芳;;三種方式防止宮腔粘連分離手術(shù)后再粘連效果的臨床觀察[A];第八次全國婦產(chǎn)科學(xué)學(xué)術(shù)會議論文匯編[C];2004年

3 成九梅;夏恩蘭;段華;;轉(zhuǎn)化生長因子β1在宮腔粘連發(fā)病機(jī)制中的作用[A];第八次全國婦產(chǎn)科學(xué)學(xué)術(shù)會議論文匯編[C];2004年

4 王慧民;;中西醫(yī)結(jié)合治療宮腔粘連的系統(tǒng)評價(jià)[A];第八屆全國中西醫(yī)結(jié)合婦產(chǎn)科學(xué)術(shù)大會論文及摘要集[C];2012年

5 張海霞;朱學(xué)平;陳芙庭;馬鑫;;經(jīng)陰道超聲三維成像在宮腔粘連診斷中的應(yīng)用價(jià)值[A];2012年浙江省超聲醫(yī)學(xué)學(xué)術(shù)年會論文集[C];2012年

6 徐開紅;;宮腔粘連的診治現(xiàn)狀[A];2012年浙江省婦產(chǎn)科學(xué)及圍產(chǎn)醫(yī)學(xué)學(xué)術(shù)年會暨《婦產(chǎn)科常見疾病規(guī)范化治療新進(jìn)展》及《圍產(chǎn)醫(yī)學(xué)熱點(diǎn)追蹤》學(xué)習(xí)班論文集[C];2012年

7 花向東;顧小燕;許鋒;張紅洋;王素敏;;200例宮腔粘連診治分析[A];中華醫(yī)學(xué)會第十次全國婦產(chǎn)科學(xué)術(shù)會議婦科內(nèi)鏡會場（婦科內(nèi)鏡學(xué)組）論文匯編[C];2012年

8 周鳳瓊;劉玉環(huán);夏恩蘭;宋冬梅;;結(jié)核性宮腔粘連的臨床診治分析[A];中華醫(yī)學(xué)會第十次全國婦產(chǎn)科學(xué)術(shù)會議婦科內(nèi)鏡會場（婦科內(nèi)鏡學(xué)組）論文匯編[C];2012年

9 董明理;;宮腔粘連的危險(xiǎn)因素分析[A];中華醫(yī)學(xué)會第十次全國婦產(chǎn)科學(xué)術(shù)會議婦科內(nèi)鏡會場（婦科內(nèi)鏡學(xué)組）論文匯編[C];2012年

10 王寶金;申愛榮;楊淑玲;王魯文;白樺;;宮腔粘連316例臨床療效分析[A];中華醫(yī)學(xué)會第十次全國婦產(chǎn)科學(xué)術(shù)會議婦科內(nèi)鏡會場（婦科內(nèi)鏡學(xué)組）論文匯編[C];2012年

相關(guān)重要報(bào)紙文章 前1條

1 程懷孟;人流后當(dāng)心宮腔粘連[N];大眾衛(wèi)生報(bào);2009年

相關(guān)博士學(xué)位論文 前3條

1 劉麗文;中藥滋腎養(yǎng)膜方對宮腔粘連內(nèi)膜修復(fù)和妊娠結(jié)局的臨床研究[D];湖南中醫(yī)藥大學(xué);2015年

2 楊茜;經(jīng)宮腔鏡宮腔粘連分離術(shù)后戊酸雌二醇應(yīng)用療效分析[D];中南大學(xué);2013年

3 林小娜;改善宮腔粘連預(yù)后的臨床和動(dòng)物實(shí)驗(yàn)研究[D];浙江大學(xué);2015年

相關(guān)碩士學(xué)位論文 前10條

1 張建潔;宮腔粘連分離術(shù)對妊娠結(jié)局的影響(附76例報(bào)道)[D];河北醫(yī)科大學(xué);2015年

2 祁鑫;陰道用芬嗎通對宮腔粘連的療效觀察[D];河北醫(yī)科大學(xué);2015年

3 王麗華;宮腔粘連的臨床分析[D];福建醫(yī)科大學(xué);2012年

4 呂倩;126例宮腔粘連患者臨床資料回顧分析[D];河北醫(yī)科大學(xué);2014年

5 馬文琴;醫(yī)用膜聯(lián)合球囊預(yù)防宮腔粘連術(shù)后再粘連的療效觀察和機(jī)理研究[D];蘇州大學(xué);2015年

6 陳禹橋;宮腔鏡診治宮腔粘連242例臨床分析[D];重慶醫(yī)科大學(xué);2015年

7 張潔;宮腔鏡治療宮腔粘連的臨床觀察[D];中南大學(xué);2009年

8 孔偉;宮腔鏡診治宮腔粘連77例臨床分析[D];重慶醫(yī)科大學(xué);2010年

9 何敏;經(jīng)陰道宮腔聲學(xué)造影在宮腔粘連診斷和治療中的應(yīng)用價(jià)值[D];四川大學(xué);2006年

10 DR UMME SALMA（沙爾瑪）;重度宮腔粘連的一個(gè)新治療方案的臨床療效觀察[D];中南大學(xué);2011年

，

本文編號：1381038