李放

[摘要] 目的 探讨米非司酮联合米索前列醇用于绝经后妇女宫腔镜手术前扩张宫颈的临床疗效。 方法 选择2012年8月～2015年8月在我院需行宫腔镜检查、治疗的绝经后妇女90例。将其随机分为Ⅰ组（30例）、Ⅱ组（30例）、Ⅲ（30例）。Ⅰ组：术前不予药物处理；Ⅱ组：术前3 h阴道后穹隆塞入米索前列醇400 μg；Ⅲ组：术前36 h开始口服米非司酮50 mg/12 h，连服3次，术前3 h，阴道后穹隆塞入米索前列醇400 μg。观察三组患者术中宫颈扩张程度、腹痛程度及人工流产综合征的发生率。 结果 Ⅲ组患者术中的宫颈扩张度，腹痛程度与其他组比较，差异有统计学意义（P<0.05）。人工流产综合征发生率：Ⅰ组与Ⅱ组比较、Ⅰ组与Ⅲ组比较，差异有统计学意义（P<0.05）；Ⅱ组与Ⅲ组比较，差异无统计学意义（P>0.05）。 结论 米非司酮联合米索前列醇用于绝经后妇女宫腔镜手术前宫颈的预处理时有软化、扩张宫颈，减轻术中腹痛程度，减少人工流产综合征发生的作用，是一种安全、有效、经济的绝经后妇女宫腔镜术前宫颈预处理的药物，值得临床推广应用。

[关键词] 米非司酮；米索前列醇；绝经；宫腔镜

[中图分类号] R984 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0147-04

[Abstract] Objective To explore the clinical curative effects of mifepristone complicated with misoprostol in the cervical dilatation before hysteroscopic surgery for postmenopausal women. Methods 90 postmenopausal women who were examined and treated under hysteroscopy in our hospital from August 2012 to August 2015 were selected.They were randomly assigned to the group Ⅰ（30 cases），group Ⅱ（30 cases） and group Ⅲ（30 cases）.The group Ⅰ：Drug administration was not given before surgery.Group Ⅱ：3 h before surgery，400 μg of misoprostol was sucked into the posterior fornix.Group Ⅲ：36 h before surgery，50 mg/12 h mifepristone was orally administrated for 3 times continuously，3 h before the surgery，400 μg of misoprostol was sucked into the posterior fornix.Cervical dilatation degree during surgery，degree of abdominal patients and incidence rate of induced abortion syndrome were observed among the three groups of patients. Results The differences of degree of cervical dilatation during surgery，and the degree of abdominal pain in the group Ⅲ，compared with other groups，were statistically significant（P<0.05）.The differences of the incidence rate of induced abortion syndrome compared between the group Ⅰ and group Ⅱ，and between the group Ⅰ and group Ⅲ was statistically significant respectively（P<0.05）.There was no difference compared between group Ⅱ and group Ⅲ（P>0.05）. Conclusion Mifepristone combined with misoprostol has the effects of softening，cervical dilatation，reducing abdominal degree during surgery and alleviating induced abortion syndrome in the pretreatment of cervix before hysteroscopic surgery for postmenopausal women.It is a safe，effective and economical drug for the pretreatment of cervix before hysteroscopic surgery for postmenopausal women，which is worthy of clinical promotion and application.

[Key words] Mifepristone；Misoprostol；Menopause；Hysteroscopy

宫腔镜技术是一项新的、微创性妇科诊疗技术，能直接清晰地观察宫腔内的各种改变，对宫腔内疾病进行诊断和治疗。其自身的创伤比值最小，被誉为微创手术的典范[1]。不断成熟和发展的宫腔镜技术已经成为诊治宫腔内疾病的首选技术手段。为减轻患者痛苦和减少手术并发症的发生，充分扩张宫颈是手术成功的保证。妇女绝经后，其卵巢分泌雌、孕激素呈进行性下降，宫颈组织越来越萎缩，质地变硬、弹性变差、扩张宫颈变得困难，增加了宫腔镜检查的难度，若强行暴力扩张宫颈，可能出现宫颈损伤、子宫穿孔等严重并发症。……