大剂量雌激素对中重度宫腔粘连预后的影响

摘要

目的 探讨大剂量雌激素对中重度宫腔粘连(IUA)预后的影响及子宫内膜雌激素受体(ER)与预后的相关性.方法 中重度IUA患者60例,宫腔镜IUA分离术(TCRA)术后辅助大剂量雌激素(戊酸雌二醇10 mg/d)治疗.实验组30例,雌激素连续治疗3个月.对照组30例,雌激素人工周期治疗3个月.术后1、3个月行宫腔镜检查.结果 随访6 ～12个月,术后3个月宫腔形态恢复总有效率为88.3％ (53/60),其中实验组90％(治愈46.7％、好转43.3％)、对照组86.7％(治愈46.7％、好转40％)(P＞0.05).术后6个月月经改善总有效率为76.7％ (46/60),其中实验组90％(治愈46.7％、好转43.3％)、对照组63.3％(治愈23.3％、好转40％)(P＜0.05).术后宫腔形态恢复有效率与ER阳性率呈正相关(r=0.339,P＜0.01).术后24例试孕,已妊娠10例(41.7％).结论 中重度IUA分离术后辅以大剂量雌激素治疗能有效提高治愈率,连续用药优于人工周期治疗.随着子宫内膜ER阳性率的增加,预后效果明显增加.%Objective To investigate the effect of high dose estrogen in prognosis of moderate or serious intrauterine adhesion (IUA) and correlation between estrogen receptor with prognosis. Methods Sixty patients with serious or moder-ate IUA underwent hysteroscopic adhesiolysis. They were randomly divided into two groups, the study group; applying Es-tradiol valerate (progynova) 10 mg per os quaque die for 3 months; the control group: Estradiol valerate 10 mg per os quaque die for 21 days, provera 8 mg per os quaque die with the last 10 days as one period, and taking three periods. All patients came back to the hospital for hysteroscopy in one month and three months post operation. Results Follow-up peri-od was 6 to 12 months. The effective power was 88.3% (53/60) for all patients who uterine cavity recovered normal in 3 months postoperatively, the study group was 90% ( healing rate 46.7% , improvement rate 43.3% ) , the control group was 86.7% ( healing rate 46.7% , improvement rate 40% ) respectively ( P > 0.05 ). The effective power was 76. 7% ( 46/ 60) for all patients who menstrual returned to normal in 6 months postoperatively, the study group was 90% ( healing rate 46. 7% , improvement rate 43.3% ) , the control group was 63.3% (healing rate 23.3% , improvement rate 40% ) respec-tively (P < 0.05 ). The result of hysteroscopy post operation had positive correlation with ER positive express rate ( r = 0. 339, P < 0.01). Ten patients had gesration, pregnancy rate was 41.7% (10/24). Conclusions Patients with serious or moderate IUA treated with high dose Estradiol Valerate could reduce re-adhesion effectively, admitting had advantage continuously than periodically. As the expression of ER increasing, the prognosis of IUA got improved markedly.