戊酸雌二醇联合地屈孕酮与清宫术治疗稽留流产后宫腔内组织残留的临床对照试验
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摘要
目的对比戊酸雌二醇联合地屈孕酮片药物治疗与清宫术治疗稽留流产后宫腔内组织残留的临床疗效。方法选择120例稽留流产后宫腔内组织残留的患者作为研究对象,根据患者意愿分为2组,观察组66例行戊酸雌二醇联合地屈孕酮治疗,对照组54例行清宫术治疗。比较2组的临床治愈率、宫腔粘连、患者康复情况及生活质量状况。结果观察组治愈57例(86%),对照组治愈49例(91%),2组治愈率比较差异无统计学意义(P> 0. 05)。观察组宫腔粘连发生率及宫腔粘连程度均低于对照组(P均<0. 05)。与对照组相比,治疗后观察组患者的出血量较少、出血时间及月经复潮时间较短、子宫内膜较厚(P均<0. 05)。治疗后,观察组生活质量各项评分中躯体、角色、情绪和总分均高于对照组(P均<0. 05)。结论戊酸雌二醇联合地屈孕酮和清宫术用于稽留流产后均能有效促进宫腔内残留组织排出,戊酸雌二醇联合地屈孕酮不仅避免了子宫内膜的损伤,还能促进月经复潮,有助提高患者生活质量。
Objective To evaluate and compare the clinical efficacy between progynova combined with dydrogestrone and curettage in the treatment of intrauterine residue after missed abortion. Methods A total of 120 patients presenting with intrauterine residual tissuesfollowing missed abortion were enrolled and divided into the observation( n = 66) and control groups( n = 54) according to their willingness. In the observation group,progynova combined with dydrogesterone intervention was administered,and curettage was performed in the control group. The clinical cure rate,intrauterine adhesions and the rehabilitation and quality of life of patients were statistically compared between two groups. Results In the observation group,57 cases( 86%)were cured and 49( 91%) in the control group with no statistical significance( P > 0. 05). The incidence of intrauterine adhesions in the observation group was significantly lower than that in the control group( P <0. 05),whereas the severity of intrauterine adhesions did not significantly differ between two groups( P >0. 05). Compared with those in the control group,the bleeding volume was significantly less,the bleeding time and menstruation recovery time was considerably shorter and the endometrial thickness was significantly larger in the observation group( all P < 0. 05). After corresponding intervention,the total score,the scores of body,role and emotional grade in the observation group were significantly higher than those in the control group( all P< 0. 05). Conclusions Bothcombined use of progynova and dydrogestrone and curettage can effectively promote the discharge of intrauterine residual tissues. Progynova in combination with dydrogesterone can not only avoid the endometrial damage of endometrium,promote the recovery of menstruation,but also improve the quality of life of patients.
Objective To evaluate and compare the clinical efficacy between progynova combined with dydrogestrone and curettage in the treatment of intrauterine residue after missed abortion. Methods A total of 120 patients presenting with intrauterine residual tissuesfollowing missed abortion were enrolled and divided into the observation( n = 66) and control groups( n = 54) according to their willingness. In the observation group,progynova combined with dydrogesterone intervention was administered,and curettage was performed in the control group. The clinical cure rate,intrauterine adhesions and the rehabilitation and quality of life of patients were statistically compared between two groups. Results In the observation group,57 cases( 86%)were cured and 49( 91%) in the control group with no statistical significance( P > 0. 05). The incidence of intrauterine adhesions in the observation group was significantly lower than that in the control group( P <0. 05),whereas the severity of intrauterine adhesions did not significantly differ between two groups( P >0. 05). Compared with those in the control group,the bleeding volume was significantly less,the bleeding time and menstruation recovery time was considerably shorter and the endometrial thickness was significantly larger in the observation group( all P < 0. 05). After corresponding intervention,the total score,the scores of body,role and emotional grade in the observation group were significantly higher than those in the control group( all P< 0. 05). Conclusions Bothcombined use of progynova and dydrogestrone and curettage can effectively promote the discharge of intrauterine residual tissues. Progynova in combination with dydrogesterone can not only avoid the endometrial damage of endometrium,promote the recovery of menstruation,but also improve the quality of life of patients.
引文
[1]顾华芬,衣欢,赵海红,张丽文. 1945例稽留流产的流行病学及高危因素分析.生殖与避孕,2016,36(3):195-201.
[2]吴书仪.宫腔镜在宫腔粘连合并稽留流产或合并妊娠物残留清宫失败诊治中的应用.中国实用医药,2015,10(1):13-15.
[3] Ugurlucan FG,Iyibozkurt AC,Sen S,Kuru O,Berkman S.Pyomyoma after dilatation and curettage for missed abortion. Clin Exp Obstet Gynecol,2013,40(1):168-169.
[4]江慧英.补佳乐联合黄体酮防治稽留流产患者清宫术后宫腔粘连的临床疗效.中国计划生育学杂志,2015,23(10):674-676.
[5]魏芳,卢丽娟,赵兴元,雷俊华,仝蕊.阴道彩超诊断稽留流产药流后宫内胎组织残留132例临床分析.昆明医科大学学报,2013,34(7):110-111.
[6]冯艳萍,刘芳,张红真.米非司酮配伍米索前列醇及中药治疗稽留流产60例临床分析.时珍国医国药,2013,24(9):2180-2181.
[7]曲军英,王丽华,庄丽娟,林婉秋.宫腔粘连的宫腔镜评价与临床疗效分析.中国内镜杂志,2012,18(12):1269-1272.
[8]丁太峰,王继红,李富琴.两种清宫方法治疗稽留流产临床分析.中国现代药物应用,2016,10(15):281-282.
[9] Diedrich JT,Drey EA,Dehlendorf C,Steinauer JE. Women's questions after postabortion insertion of intrauterine contraception. Contraception,2013,88(3):396-400.
[10]周芹芳,嵇玉蓉.稽留流产患者清宫术后应用补佳乐联合黄体酮治疗预防宫腔粘连的临床分析.中国妇幼保健,2014,29(33):5448-5450.
[11]赵诗艺,刘英,杨晓葵,张军,余兰.薄型子宫内膜冻融胚胎移植周期中应用雌二醇/雌二醇地屈孕酮的疗效观察.实用妇产科杂志,2015,31(4):270-273.
[12]刘凤勤.采用宫腔镜联合补佳乐治疗难治性宫内妊娠物残留的临床疗效观察.中国内镜杂志,2013,19(7):736-738.
[13]付郁.单纯雌激素与避孕药干预对人工流产术后经期及子宫内膜厚度的影响.临床医学,2016,36(10):108-110.
[14]刘丽,齐智慧,王贺,谷娜,吴效科.保胎液对胚泡着床障碍小鼠子宫内膜降钙素表达的影响.实用妇产科杂志,2013,29(8):634-636.
[15] Borgelt LM,Martell CW. Estradiol valerate/dienogest:a novel combined oral contraceptive. Clin Ther,2012,34(1):37-55.
[16]徐晓琴,徐向荣,俞小英,何绍民.人工流产术后宫腔内组织物残留的处理.重庆医学,2014,43(26):3497-3499.
[17]张素伟,于月新.复方玄驹胶囊联合补佳乐治疗薄型子宫内膜的临床疗效研究.生殖医学杂志,2017,26(5):457-463.
[2]吴书仪.宫腔镜在宫腔粘连合并稽留流产或合并妊娠物残留清宫失败诊治中的应用.中国实用医药,2015,10(1):13-15.
[3] Ugurlucan FG,Iyibozkurt AC,Sen S,Kuru O,Berkman S.Pyomyoma after dilatation and curettage for missed abortion. Clin Exp Obstet Gynecol,2013,40(1):168-169.
[4]江慧英.补佳乐联合黄体酮防治稽留流产患者清宫术后宫腔粘连的临床疗效.中国计划生育学杂志,2015,23(10):674-676.
[5]魏芳,卢丽娟,赵兴元,雷俊华,仝蕊.阴道彩超诊断稽留流产药流后宫内胎组织残留132例临床分析.昆明医科大学学报,2013,34(7):110-111.
[6]冯艳萍,刘芳,张红真.米非司酮配伍米索前列醇及中药治疗稽留流产60例临床分析.时珍国医国药,2013,24(9):2180-2181.
[7]曲军英,王丽华,庄丽娟,林婉秋.宫腔粘连的宫腔镜评价与临床疗效分析.中国内镜杂志,2012,18(12):1269-1272.
[8]丁太峰,王继红,李富琴.两种清宫方法治疗稽留流产临床分析.中国现代药物应用,2016,10(15):281-282.
[9] Diedrich JT,Drey EA,Dehlendorf C,Steinauer JE. Women's questions after postabortion insertion of intrauterine contraception. Contraception,2013,88(3):396-400.
[10]周芹芳,嵇玉蓉.稽留流产患者清宫术后应用补佳乐联合黄体酮治疗预防宫腔粘连的临床分析.中国妇幼保健,2014,29(33):5448-5450.
[11]赵诗艺,刘英,杨晓葵,张军,余兰.薄型子宫内膜冻融胚胎移植周期中应用雌二醇/雌二醇地屈孕酮的疗效观察.实用妇产科杂志,2015,31(4):270-273.
[12]刘凤勤.采用宫腔镜联合补佳乐治疗难治性宫内妊娠物残留的临床疗效观察.中国内镜杂志,2013,19(7):736-738.
[13]付郁.单纯雌激素与避孕药干预对人工流产术后经期及子宫内膜厚度的影响.临床医学,2016,36(10):108-110.
[14]刘丽,齐智慧,王贺,谷娜,吴效科.保胎液对胚泡着床障碍小鼠子宫内膜降钙素表达的影响.实用妇产科杂志,2013,29(8):634-636.
[15] Borgelt LM,Martell CW. Estradiol valerate/dienogest:a novel combined oral contraceptive. Clin Ther,2012,34(1):37-55.
[16]徐晓琴,徐向荣,俞小英,何绍民.人工流产术后宫腔内组织物残留的处理.重庆医学,2014,43(26):3497-3499.
[17]张素伟,于月新.复方玄驹胶囊联合补佳乐治疗薄型子宫内膜的临床疗效研究.生殖医学杂志,2017,26(5):457-463.