高丽萍

【摘要】 目的：探析重度子宮腔粘连患者采用高剂量雌孕激素序贯辅助宫腔镜手术治疗的临床效果。方法：2020年5月—2023年1月抽选乳山市中医院收治的86例重度子宫腔粘连患者，采用随机数字表法分为观察组（n=43）、对照组（n=43）。两组患者均行宫腔镜下宫腔粘连分离术治疗，对照组患者术后行低剂量雌孕激素序贯治疗，观察组患者术后行高剂量雌孕激素序贯治疗。比较两组子宫内膜厚度、子宫体积、性激素水平、生活质量评分、宫腔再粘连发生率。结果：治疗后观察组子宫内膜厚度、子宫体积均大于对照组，差异均有统计学意义（P<0.05）；治疗后观察组性激素水平均高于对照组，差异均有统计学意义（P<0.05）；治疗后观察组生活质量评分均高于对照组，差异均有统计学意义（P<0.05）；观察组宫腔再粘连发生率低于对照组，差异有统计学意义（P<0.05）。结论：重度子宫腔粘连患者采用高剂量雌孕激素序贯辅助宫腔镜治疗可增加子宫内膜厚度及子宫体积，改善性激素水平，提高生活质量，降低宫腔再粘连发生率。

【关键词】 雌孕激素序贯 宫腔镜下宫腔粘连分离术治疗 重度子宫腔粘连

Effect of High-dose Sequential Estrogen and Progesterone Assisted Hysteroscopy in the Treatment of Severe Intrauterine Adhesion/GAO Liping. //Medical Innovation of China， 2024， 21（07）： 0-040

[Abstract] Objective： To explore the clinical effect of high-dose sequential estrogen and progesterone assisted hysteroscopy in patients with severe intrauterine adhesion. Method： A total of 86 patients with severe intrauterine adhesion admitted to Rushan City Hospital of Traditional Chinese Medicine from May 2020 to January 2023 were selected and divided into observation group （n=43） and control group （n=43） according to random number table method. Patients in both groups were treated with hysteroscopic adhesiolysis of intrauterine adhesion. Patients in the control group were treated with low-dose sequential estrogen and progesterone and patients in the observation group were treated with high-dose sequential estrogen and progesterone. Endometrial thickness， uterine volume， sex hormone level， quality of life score and incidence of intrauterine readhesion were compared between the two groups. Result： After treatment， endometrial thickness and uterine volume in observation group were higher than those in control group， the differences were statistically significant （P<0.05）. After treatment， the sex hormone levels in observation group were higher than those in control group， the differences were statistically significant （P<0.05）. After treatment， the quality of life scores of observation group were higher than those of control group， the differences were statistically significant （P<0.05）. The incidence of intrauterine readhesion in observation group was lower than that in control group， the difference was statistically significant （P<0.05）. Conclusion： High-dose sequential estrogen and progesterone assisted hysteroscopy in patients with severe intrauterine adhesion can increase endometrial thickness and uterine volume， improve sex hormone levels， improve quality of life， and reduce the incidence of intrauterine readhesion.

[Key words] Sequential estrogen and progesterone Hysteroscopic adhesiolysis of intrauterine adhesion Severe intrauterine adhesion

First-author's address： Department of Obstetrics and Gynecology， Rushan City Hospital of Traditional Chinese Medicine， Rushan 264500， China

doi：10.3969/j.issn.1674-4985.2024.07.009

子宫腔粘连为临床高发妇科疾病，主要指子宫内膜受损所致子宫腔部分或完全闭塞，其致病原因包括子宫内膜感染或创伤、雌激素水平过低、遗传、子宫先天畸形等，患者主要症状为腹痛、月经异常等，可影响女性正常受孕[1]。临床治疗子宫腔粘连的关键为恢复子宫正常体积及形态，修复子宫内膜组织，缓解临床症状，预防粘连复发[2]。宫腔镜下宫腔粘连分离术为重度子宫腔粘连的常规治疗方案，利用宫腔镜探查可确定子宫腔形态及粘连部位、程度、累及范围，进而精确分离粘连，但术后复发率较高[3-4]。临床研究表明，宫腔镜手术治疗后辅助应用雌孕激素治疗可降低再粘连发生率，但关于用药剂量仍存争议[5]。本研究抽选86例重度子宫腔粘连患者，探析高剂量雌孕激素序贯辅助宫腔镜手术治疗的临床效果。……