本文選題：雌激素　切入點：劑量　出處：《中華婦幼臨床醫(yī)學雜志(電子版)》2016年05期 　論文類型：期刊論文

【摘要】：目的探討重度宮腔黏連(SIUA)患者宮腔鏡下經宮頸宮腔黏連分離術(TCRA)后,應用不同劑量雌激素對黏連復發(fā)和月經的影響。方法選擇2010年1月至2015年6月,于南京醫(yī)科大學第一附屬醫(yī)院接受宮腔鏡下TCRA的275例SIUA患者為研究對象。根據(jù)TCRA后雌激素治療劑量,將其分為低劑量組(n=89)、中劑量組(n=82)、高劑量組(n=73)及對照組(n=31)。低、中、高劑量組TCRA后分別給予戊酸雌二醇3、6、9mg/d×21d聯(lián)合醋酸甲羥孕酮10mg/d×5d治療,對照組TCRA后未給予任何雌激素治療。統(tǒng)計學分析4組患者年齡、孕次、產次、既往宮腔手術史、子宮內膜厚度、宮腔深度,治療前、后美國生育協(xié)會(AFS)評分及月經情況,治療后妊娠、不良反應情況及治療療效。結果 14組患者年齡、孕次、產次、既往宮腔手術史,以及TCRA前繼發(fā)性閉經、月經量減少、繼發(fā)不孕、復發(fā)性或稽留流產、周期性下腹痛、子宮內膜厚度及宮腔深度等一般臨床資料比較,差異均無統(tǒng)計學意義(P0.05)。2不同劑量雌激素治療前、后,4組AFS評分下降值比較,差異有統(tǒng)計學意義(F=43.750,P=0.000);而低、中、高劑量組均較對照組顯著增高,并且差異均有統(tǒng)計學意義(t=7.011、7.199、6.292,均為P=0.000)。低、中、高劑量組患者治療前、后AFS評分下降值兩兩比較,治療后4組患者月經恢復正常和月經量增多比例分別比較,以及治療后低、中、高劑量組患者閉經或月經量過少比例兩兩比較,差異均無統(tǒng)計學意義(P0.05)。治療后4組患者閉經或月經量過少比例比較,差異有統(tǒng)計學意義(χ~2=39.490,P=0.000)。低、中、高劑量組患者閉經或月經量過少比例,均較對照組低,并且差異均有統(tǒng)計學意義(χ~2=14.623、27.265、21.105,均為P=0.000)。34組不良反應率比較,差異有統(tǒng)計學意義(χ~2=37.182,P=0.000)。低、中、高劑量組不良反應率均較對照組高,高劑量組不良反應率高于低、中劑量組,并且差異均有統(tǒng)計學意義(P0.05);低、中劑量組不良反應率比較,以及4組患者因不良反應導致停藥率比較,差異均無統(tǒng)計學意義(P0.05)。44組患者治療總有效率比較,差異有統(tǒng)計學意義(χ~2=39.490,P=0.000)。其中,低、中、高劑量組患者治療總有效率,均較對照組高,差異均有統(tǒng)計學意義(P0.05);低、中、高劑量組患者治療總有效率分別兩兩比較,以及4組患者妊娠率比較,差異均無統(tǒng)計學意義(P0.05)。結論 SIUA患者TCRA后,應用雌激素治療,可有效減少SIUA復發(fā),改善患者月經狀況。不同劑量雌激素治療SIUA患者,療效無明顯差異。
[Abstract]:Objective to investigate the effects of different doses of estrogen on relapse and menstruation of severe intrauterine adhesion syndrome (SIUAA) patients after hysteroscopic hysteroscopy. Two hundred and five patients with TCRA received hysteroscopy in the first affiliated Hospital of Nanjing Medical University were studied. According to the dose of estrogen after TCRA, they were divided into three groups: low dose group, middle dose group, high dose group and control group. The high dose group was treated with estradiol valerate (Estradiol valerate) 6 mg / d 脳 21 d and medroxyprogesterone acetate 10 mg / d 脳 5 d after TCRA, while the control group was not treated with any estrogen after TCRA. Results the age, pregnancy, labor, history of intrauterine surgery, and secondary amenorrhea before and after treatment, and secondary amenorrhea before and after TCRA, were evaluated in 14 groups, including the depth of uterine cavity, the score of AFS before and after treatment, the status of pregnancy, adverse reactions and therapeutic effects. There was no significant difference in menstrual volume, secondary infertility, recurrent or missed abortion, periodic lower abdominal pain, endometrial thickness and uterine cavity depth before treatment with different doses of estrogen. The decrease of AFS score in the 4 groups was significantly higher than that in the control group (P < 0.05), and the difference was statistically significant in the low, middle and high dose groups than in the control group, and the difference was statistically significant (P < 0.01 / 7.1996.292). After treatment, the ratio of menorrhagia to normal menstruation and increase of menstrual volume in 4 groups were compared respectively, and the proportion of amenorrhea or menorrhagia in low, middle and high dose groups after treatment were compared. The difference was not statistically significant (P 0.05). After treatment, the proportion of amenorrhea or menorrhagia in the four groups was significantly lower than that in the control group (蠂 ~ 2 ~ 2 ~ 39.490 ~ 0.000 ~ 0.000), and the proportion of amenorrhea or menstrual volume in the middle and high dose group was lower than that in the control group. And the difference was statistically significant (蠂 ~ (2 +) ~ (14) 623 ~ 27.265U ~ (21.105)), the adverse reaction rate was significantly higher in the high dose group than that in the middle and high dose group, and was higher in the middle and high dose group than that in the middle dose group, and was higher in the middle dose group than in the middle dose group, and the difference was statistically significant (蠂 ~ (2 +) ~ (2)) ~ (37. 182) P ~ (0.000), P ~ (0.000) and P ~ (0.000) (P < 0.05). The difference was statistically significant (P 0.05), the adverse reaction rate of low and middle dose groups was higher than that of low dose group, and the total effective rate of treatment was not significant in 4 groups of patients due to adverse reactions. There was no significant difference in the total effective rate of treatment in group P0.05. 44, there was no significant difference in the total effective rate of treatment between the two groups. The difference was statistically significant (蠂 ~ (2 +)) 39.490 (P ~ (0.000)). Among them, the total effective rate of low, middle and high dose groups was higher than that of the control group (P < 0.05), and the total effective rate of low, middle and high dose groups was respectively two comparisons. There was no significant difference in pregnancy rate among the four groups (P 0.05). Conclusion estrogen therapy can effectively reduce the recurrence of SIUA and improve menstrual status after TCRA in patients with SIUA. Different doses of estrogen can be used to treat SIUA patients. There was no significant difference in curative effect.
【作者單位】： 南京醫(yī)科大學第一附屬醫(yī)院婦科;
【基金】：江蘇省衛(wèi)生計生委基金資助項目([2013]8號)~~
【分類號】：R713.4
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本文編號：1593339