池余刚，杨晓煜，何萍，雷丽，兰易，刘禄斌

(重庆市妇幼保健院，重庆　400020)



经皮雌二醇凝胶用于中重度宫腔粘连术后辅助治疗的研究

池余刚，杨晓煜*，何萍，雷丽，兰易，刘禄斌

(重庆市妇幼保健院，重庆400020)

目的探讨经皮雌二醇凝胶用于中重度宫腔粘连(IUA)电切术(TCRA)后辅助治疗的临床效果。方法采用前瞻性随机单盲的方法，将我院确诊为中重度IUA并实施TCRA+宫腔球囊置入术后的患者48例随机分为研究组(25例)和对照组(23例)。研究组术后给予经皮雌二醇凝胶5 mg，2次/d，连续治疗1月；对照组给予补佳乐3 mg，2次/d，连续治疗1月。比较两组患者排卵日子宫内膜增长情况、治疗后月经量及宫腔形态恢复情况、治疗前后AFS评分、重复行TCRA的次数及不良反应发生情况。结果两组患者排卵日子宫内膜厚度比较无显著性差异(P>0.05)；药物治疗后两组患者月经量均明显改善，但两组间比较无显著性差异(P>0.05)；虽然两组患者治疗后美国生育协会(AFS)评分总分无显著性差异[(4.52±1.67) vs. (5.31±1.58)分](P>0.05)，但研究组粘连类型分值显著低于对照组[(1.15±0.22) vs. (1.72±0.59)分](P<0.05)；术后随访6月，研究组重复行TCRA的次数[(2.15±0.34)次]显著低于对照组[(3.34±0.52)次](P<0.05)；药物治疗过程中研究组患者无不良反应发生，对照组有2例出现恶心、头晕，1例肝功轻度异常。结论经皮雌二醇凝胶用于中重度IUA术后辅助治疗可以有效改善患者TCRA术后子宫内膜状况和月经量，值得临床推广。

经皮雌二醇凝胶；宫腔粘连；宫腔粘连电切术；AFS评分

【Abstract】

Objective： To assess the efficiency of estradiol gel in treatment of moderate or severe intrauterine adhesion.

Methods： Forty eight women with moderate or severe intrauterine adhesion (IUA) were treated by transcervical resection of adhesion (TCRA) combined with intrauterine balloon placement. The patients were randomly divided into two groups： the patients were post-operatively given 5 mg estradiol gel，2 times/day in the study group (n=25)，while the patients were treated with 3 mg estradiol valerate，2 times/day in control group (n=23). The patients were treated continuously for one month in both groups. The changes of endometrial thickness and menstrual flow，AFS score before and after treatment，the times of TCRA，adverse reactions were compared between the two groups.

Results： The endometrium thickness was not significantly different between the two groups (P>0.05). Menstrual flow was improved in both group，and there was no significant difference between the two groups (P>0.05). Although the AFS score [(4.52±1.67) vs. (5.31±1.58)] was not significantly different between the two groups (P>0.05)，the AFS score in adhesion type group was significantly lower than that in control group [(1.15±0.22) vs. (1.72±0.59)] (P<0.05). The times of TCRA [(2.15±0.34) vs. (3.34±0.52)] in the study group was significantly less than that in the control group after 6 months follow-up (P<0.05). During the process of drug treatment，there were 2 patients suffered nausea and dizziness，one abnormal liver function in the control group，and there was no adverse reaction in the study group.

Conclusion： Transdermal estradiol gel for postoperative adjuvant therapy of moderate or severe IUA can effectively improve the endometrial status and menstrual flow. It is worthy of clinical promotion.

(JReprodMed2016，25(8)：691-695)

宫腔粘连(IUA)是指由于各种因素所致宫腔基底层内膜损伤后，宫腔肌壁相互粘连。临床表现为闭经或月经量减少、周期性腹痛、稽留流产、不孕以及妊娠后期胎盘植入、胎儿生长受限、产后出血等，严重影响女性健康[1]。IUA的治疗方案至今尚未统一，存在一定的分歧，但各有特色。宫腔粘连电切术(TCRA)是目前治疗IUA的首选方法。中重度IUA治疗难度大，术后粘连容易复发，严重影响患者的生育功能，目前主要采取电切粘连、促进子宫内膜修复和预防IUA复发相结合的综合性治疗方法[2]。我院妇科采用……