雌孕激素和透明质酸钠凝胶辅助宫腔镜治疗宫腔粘连的临床观察
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摘要
目的观察雌孕激素和透明质酸钠凝胶辅助宫腔镜在宫腔粘连治疗中效果。方法 60例宫腔粘连患者采用宫腔镜下宫腔粘连分离术后,随机分为对照组与实验组,对照组宫腔放置节育环,实验组则用透明质酸钠凝胶及雌二醇和孕激素周期治疗;比较两组疗效、月经情况、美国生育协会宫腔黏连评分(AFS评分)、妊娠结局和粘连复发情况。结果实验组疗效优于对照组,经期时间及月经量多于对照组,宫腔粘连AFS评分、复发率和不良妊娠发生率均低于对照组(P<0.01或0.05)。结论雌孕激素和透明质酸钠凝胶辅助宫腔镜治疗可显著提高宫腔粘连的疗效,改善妊娠结局。
Objective To observe the clinical efficacy of hysteroscopic adhesiolysis(HA) with estrogen, progesterone and sodium hyaluronate gel(SHG) in intrauterine adhesion(IUA). Methods Sixty IUA cases underwent HA, and then received preventive therapy with intrauterine device(control group) or SHG and periodic treatment of estrogen and progestogen(experimental group). Clinical efficacy, menstrual status, American Fertility Society(AFS) IUA scores,pregnancy outcomes, and IUA recurrence were compared between two groups. Results Compared with control group,therapeutic effect and menstrual period and volume were increased, while AFS scores, IUA recurrence and abnormal pregnancy outcomes decreased in experimental group(P<0.01 or 0.05). Conclusion Combined estrogen, progesterone and SHG can improve the therapeutic efficacy and pregnancy outcomes in IUA patients undergoing HA.
Objective To observe the clinical efficacy of hysteroscopic adhesiolysis(HA) with estrogen, progesterone and sodium hyaluronate gel(SHG) in intrauterine adhesion(IUA). Methods Sixty IUA cases underwent HA, and then received preventive therapy with intrauterine device(control group) or SHG and periodic treatment of estrogen and progestogen(experimental group). Clinical efficacy, menstrual status, American Fertility Society(AFS) IUA scores,pregnancy outcomes, and IUA recurrence were compared between two groups. Results Compared with control group,therapeutic effect and menstrual period and volume were increased, while AFS scores, IUA recurrence and abnormal pregnancy outcomes decreased in experimental group(P<0.01 or 0.05). Conclusion Combined estrogen, progesterone and SHG can improve the therapeutic efficacy and pregnancy outcomes in IUA patients undergoing HA.
引文
[1]陈芳,段华,张颖,等.不同水平雌激素在宫腔粘连形成中的作用及相关机制[J].中华妇产科杂志, 2010, 45(12):917-920.
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[7]楚光华,刘晨,胡春艳,等.宫腔镜下宫腔粘连分离术后预防再次粘连的3种方法的临床效果分析[J].中华妇幼临床医学杂志(电子版), 2017, 13(3):349-353.
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[10]孙玲玲,贾塞玉,沈晓慧,等.经阴道三位超声诊断宫腔粘连68例诊断结果及意义分析[J].影响研究及医学应用,2018, 2(2):187-189.
[11]赵筱丹,田慧玉,王心佳.经阴道三维超声成像技术诊断宫腔粘连的价值探讨[J].哈尔滨医科大学学报, 2018, 52(5):488-490.
[12]程丹,杨菁,李洁,等.促性腺激素释放激素类似物联合小剂量雌激素预防中、重度粘连复发的治疗分析[J].中华妇幼临床医学杂志(电子版), 2017, 13(4):432-437.
[13]丛莉.中药联合人工周期预防宫腔镜分离术后子宫粘连患者再粘连的临床效果分析[J].饮食健康, 2018, 5(6):83-84.
[14]秦天华,常君.宫腔粘连分离术后人工周期宫腔置球囊尿管定期扩宫预防再粘连的临床应用研究[J].新疆医学,2018, 48(11):1199-1202.
[15]庞琴霞,柳州,王鹰.宫腔镜下粘连分离术后放置可吸收生物医用膜在预防重度宫腔粘连复发中的应用[J].中国计划生育和妇产科, 2018, 10(8):30-32, 36.
[16]谢燕,刘强,罗幼珍,等.透明质酸钠凝胶预防人工流产术后宫腔粘连有效性及安全性的Meta分析[J].中华生殖与避孕杂志, 2018, 38(11):920-926.
[17]魏彩平,杨岚.雌孕激素联合透明质酸钠凝胶辅助治疗宫腔镜下重度宫腔粘离分离术患者的效果观察[J].临床合理用药杂志, 2017, 10(1):45-47.
[2] JOHARY J, XUE M, ZHU X, et al. Efficacy of estrogen therapy in patients with intrauterine adhesions:systematic review[J]. J Minim Invasive Gynecol, 2014, 21(1):44-54.
[3] WANG X, DUAN H. Clinical evaluation of amniotic products after transcervical resection of intensive degree of intrauterine adhesions[J]. Chin J Obste Gyneco, 2016,51(1):27-30.
[4] KIM M J, LEE Y, LEE C, et al. Accuracy of three dimensional ultrasound and treatment outcomes of intrauterine adhesion in infertile women[J]. Taiwan J Obstet Gynecol, 2015, 54(6):737-741.
[5]吴琼蔚,谢晖亮,马成斌,等.宫腔粘离767例临床分析[J].实用妇产科杂志, 2014, 30(5):354-357.
[6]谢家滨,陈光元,李日红,等.宫腔粘连的相关危险因素及宫腔镜下手术治疗效果分析[J].海南医学, 2018, 29(3):425-426.
[7]楚光华,刘晨,胡春艳,等.宫腔镜下宫腔粘连分离术后预防再次粘连的3种方法的临床效果分析[J].中华妇幼临床医学杂志(电子版), 2017, 13(3):349-353.
[8]黄乐.不同治疗方案预防中-重度宫腔粘连分离术后再粘连的疗效比较[J].医学临床研究, 2017, 34(2):389-391.
[9]朱金虎,洪小山,周燕.玻璃酸钠凝胶预防中度宫腔粘连复发的疗效分析[J].中华妇幼临床医学(电子版), 2018,14(1):104-108.
[10]孙玲玲,贾塞玉,沈晓慧,等.经阴道三位超声诊断宫腔粘连68例诊断结果及意义分析[J].影响研究及医学应用,2018, 2(2):187-189.
[11]赵筱丹,田慧玉,王心佳.经阴道三维超声成像技术诊断宫腔粘连的价值探讨[J].哈尔滨医科大学学报, 2018, 52(5):488-490.
[12]程丹,杨菁,李洁,等.促性腺激素释放激素类似物联合小剂量雌激素预防中、重度粘连复发的治疗分析[J].中华妇幼临床医学杂志(电子版), 2017, 13(4):432-437.
[13]丛莉.中药联合人工周期预防宫腔镜分离术后子宫粘连患者再粘连的临床效果分析[J].饮食健康, 2018, 5(6):83-84.
[14]秦天华,常君.宫腔粘连分离术后人工周期宫腔置球囊尿管定期扩宫预防再粘连的临床应用研究[J].新疆医学,2018, 48(11):1199-1202.
[15]庞琴霞,柳州,王鹰.宫腔镜下粘连分离术后放置可吸收生物医用膜在预防重度宫腔粘连复发中的应用[J].中国计划生育和妇产科, 2018, 10(8):30-32, 36.
[16]谢燕,刘强,罗幼珍,等.透明质酸钠凝胶预防人工流产术后宫腔粘连有效性及安全性的Meta分析[J].中华生殖与避孕杂志, 2018, 38(11):920-926.
[17]魏彩平,杨岚.雌孕激素联合透明质酸钠凝胶辅助治疗宫腔镜下重度宫腔粘离分离术患者的效果观察[J].临床合理用药杂志, 2017, 10(1):45-47.