黄永申　蒙凤明

[摘要]目的 探讨戊酸雌二醇片联合安宫黄体酮预防中重度宫腔粘连松解术后再次宫腔粘连的效果。方法 回顾性分析2015年1月～2017年12月我院收治行中重度宫腔粘连松解术患者64例，按照治疗方案的不同分为手术组（n=31）与联合组（n=33），两组均行宫腔镜下宫腔粘连松解术并在术后放置节育环，联合组则给予戊酸雌二醇片+安宫黄体酮治疗，比较两组术后持续出血时间、出血量及腹痛、宫腔粘连复发情况。结果 联合组治疗后宫腔粘连复发率为19.35%，明显低于手术组的41.94%（P<0.05）；联合组术后出血时间、腹痛持续时间、月经恢复时间短于手术组，术后出血量少于手术组，子宫内膜厚度优于手术组，差异均有统计学意义（P<0.05）；两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论 戊酸雌二醇片配合安宫黄体酮可有效预防中重度宫腔粘连松解术后再次宫腔粘连发生率，促进子宫修复且不增加治疗不良反应发生率。

[关键词]宫腔粘连；安宫黄体酮；戊酸雌二醇；宫腔镜

[中图分类号] R713.4 [文献标识码] A [文章编号] 1674-4721（2018）7（b）-0072-04

[Abstract] Objective To investigate the effect of Estradiol Valerate Tablets combined with Medroxyprogesterone in the prevention of intrauterine adhesion after moderate and severe intrauterine adhesion debonding. Methods A retrospective analysis of 64 patients with severe intrauterine adhesions in our hospital from January 2015 to December 2017 was divided into operation group （n=31） and combined group （n=33） according to different treatment method. Both groups underwent laparoscopic intrauterine adhesioslysis and placement of IUD after operation. The combination group was treated with Estradiol Valerate Tablets and progesterone. The duration of postoperative bleeding was compared between the two groups， bleeding and abdominal pain， cervical adhesions. Results The recurrence rate of intrauterine adhesions in the combined group was 19.35%， which was significantly lower than that in the operation group （41.94%） （P<0.05）. The postoperative bleeding time， duration of abdominal pain， menstruation recovery time was shorter than that in the operation group， the bleeding volume was lesser than that in the operation group and endometrial thickness in the combined group were better than those in the operative group， the differences were statistically significant （P<0.05） .There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusion Estradiol Valerate and progesterone acetate can effectively prevent the occurrence of uterine adhesions and increase the incidence of uterine adhesions after moderate-to-severe intrauterine adhesions release without increasing the incidence of adverse reactions.

[Key words] Intrauterine adhesions； Progesterone； Estradiol Valerate； Hysteroscopy

宮腔粘连（intrauterine adhesion，IUA）作为临床妇科常见疾病之一，通常由于宫腔感染、手术等原因造成子宫内膜基底层损伤而发生子宫腔内粘连[1]，患者多因月经异常、闭经、不孕不育就诊[2]。随着经济发展与文化观念越来越开放，人工流产率升高导致宫腔粘连发病率逐年升高。宫腔镜宫腔粘连分离术（transcervical resection of adhesions，TCRA）是治疗宫腔粘连的标准术式[3-4]，但研究发现宫腔粘连松解术后复发率高达3.1%～23.5%，中重度宫腔粘连患者术后复发率更高达20.0%～62.5%[5-6]，临床预防术后粘连复发常用方法多有术后放置宫内节育器、球囊扩张法、生物胶类、羊膜移植等[7]，但效果各异。我院于2015年起给予中重度宫腔粘连患者TCRA术后……