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目的:探讨雌激素(戊酸雌二醇)用于中、重度宫腔粘连术后的辅助治疗的最佳剂量。方法:选取90例宫腔镜下确诊为中、重度宫腔粘连患者,成功施行宫腔镜下粘连分离术,术后宫腔留置Foley尿管水囊,随机分成3组,每组30例,给予不同剂量雌激素人工周期治疗3个月,A组4 mg/d,B组8 mg/d,C组12 mg/d。定期随访观察患者的月经、宫腔形态、内膜厚度及对有生育要求者随访1年内的妊娠情况。结果:对于中度粘连,B、C组在改善月经、恢复宫腔形态及增加内膜厚度上明显优于A组,差异有统计学意义(P<0.05),B、C组间差异无统计学意义(P>0.05);对于重度粘连,3组间差异均无统计学意义(P>0.05);A、B、C组1年内妊娠率分别为40.0%(4/10),33.3%(4/12)和35.3%(6/17),差异无统计学意义(P>0.05)。结论:对于中度宫腔粘连,适当运用大剂量雌激素能明显提高治疗有效率,增加内膜厚度,预防再次粘连,且安全可行;但不必盲目增加雌激素剂量而相应增加药物的不良风险。对于重度宫腔粘连,大剂量雌激素未能明显提高治疗有效率,且3组辅助治疗后均未有效提高术后妊娠率。
Objective: To explore the best dose of adjuvant estrogen (estradiol valerate) for moderate and severe intrauterine adhesions. Methods: Ninety patients diagnosed as moderate or severe intrauterine adhesions under hysteroscopy were selected and successfully treated with hysteroscopic adhesion separation. The Foley catheter balloon was placed in the uterine cavity and randomly divided into three groups (n = 30 in each group) The patients were treated with artificial estrogen at different dosages for 3 months, 4 mg / d in group A, 8 mg / d in group B and 12 mg / d in group C respectively. Regular follow-up observation of the patient’s menstruation, uterine cavity morphology, endometrial thickness and fertility requirements were followed up within 1 year of pregnancy. Results: For moderate adhesions, B and C groups were significantly better than A group in improving menstruation, restoring uterine cavity morphology and increasing intima thickness (P <0.05), but there was no statistical difference between B and C groups (P> 0.05). For severe adhesion, there was no significant difference among the three groups (P> 0.05). The pregnancy rates in groups A, B and C were 40.0% (4/10) and 33.3% 4/12) and 35.3% (6/17) respectively, with no significant difference (P> 0.05). Conclusion: For moderate intrauterine adhesions, the appropriate use of large doses of estrogen can significantly improve the treatment efficiency, increase the thickness of the intima and prevent adhesions again, and safe and feasible; but do not blindly increase the dose of estrogen and accordingly increase the adverse drug risk. For severe intrauterine adhesions, high-dose estrogen failed to significantly improve the treatment efficiency, and three groups of adjuvant therapy did not effectively improve postoperative pregnancy rate.