雌二醇凝胶在中-重度宫腔粘连电切术后的应用价值研究

Study on the application value of estradiol gel after transcervical resection of adhesion of moderate-severe intrauterine

摘要:

目的 比较雌二醇凝胶和戊酸雌二醇片在中-重度宫腔粘连（IUA）电切术后患者中的临床疗效，探索雌二醇凝胶在宫腔镜下IUA电切术（TCRA）后的应用价值。方法 回顾性分析2018年1月－2020年1月该院行TCRA的213例中-重度IUA患者的临床资料，根据术后药物剂型和给药途径不同，将患者分为经皮组（n = 109）和口服组（n = 104），经皮组使用雌二醇凝胶，口服组使用戊酸雌二醇片。比较两组患者治疗后外周血雌二醇浓度、子宫内膜厚度、美国生育学会（AFS）评分和月经量改善情况。结果 治疗后，经皮组子宫内膜厚度较口服组明显增加，AFS评分明显降低，差异均有统计学意义（P < 0.05）；两组患者外周血雌二醇浓度、月经量、妊娠率、流产率、凝血功能和肝肾功能比较，差异均无统计学意义（P > 0.05）。结论 使用TCRA治疗中-重度IUA后，应用经皮雌二醇凝胶，能明显增加子宫内膜厚度，降低AFS评分，且不降低妊娠率，值得临床推广应用。

Abstract:

Objective To compare the clinical efficacy of estradiol gel and estradiol valerate tablets in patients with moderate and severe intrauterine adhesions (IUA) after transcervical resection of adhesion (TCRA), and explore the application value of estradiol gel after electrotomy of IUA.Methods Clinical data of 213 patients with moderate-severe intrauterine adhesions who underwent TCRA from January 2018 to January 2020 were retrospectively analyzed, patients were divided into percutaneous group (n = 109) and oral group (n = 104) according to different postoperative drug dosage forms and administration routes. The concentration of estradiol in peripheral blood, endometrial thickness, American Fertility Society (AFS) score and improvement of menstrual volume were compared between the two groups after treatment.Results Compared with the oral administration group, the intimal thickness of the percutaneous administration group was significantly increased, and the AFS score was significantly decreased, with statistically significant differences (P < 0.05). There was no significant difference in peripheral blood estradiol concentration, menstrual flow, pregnancy rate, miscarriage rate, coagulation function and liver and kidney function between the two groups (P > 0.05).Conclusion The use of percutaneous estradiol gel after TCRA of moderate-severe intrauterine adhesions can significantly increase intimal thickness and reduce AFS score.