阴道给予丙酸睾丸素配伍米索前列醇在绝经后妇女取节育环中的应用  

Vaginal Testosterone Propionate with Misoprostol Therapy for Removing Intrauterine Devices in Postmenopausal Women

作　　者：沈健[1] 刘延[1] 滕宗荣[1] 孙宁霞[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025 [2]第二军医大学附属长征医院妇产科,上海200003

出　　处：《生殖与避孕》2012年第8期563-567,共5页Reproduction and Contraception

摘　　要：目的:探讨术前阴道预处理降低绝经后妇女取节育器(IUD)风险及痛苦的方法。方法:将240例绝经后取器的妇女随机分为3组,每组80例,A组:术前2周起每日使用20 g/L丙酸睾丸素鱼肝油软膏1 g/d,阴道涂抹,于取IUD前2～3 h阴道置入米索前列醇200μg;B组:术前连续7 d口服戊酸雌二醇(E2V)3 mg/d,直至手术日;C组:给予不含丙酸睾丸素鱼肝油软膏1 g/d阴道涂抹。观察手术时宫颈松弛程度、取器顺利程度、术中出血量、手术时间,采用目测模拟疼痛程度分级法评价各组疼痛程度;免疫发光分析法测定用药前、后血清雌二醇(E2)和睾酮(T)水平,B超测定子宫内膜厚度。结果:A组宫颈松弛程度、取器顺利程度、术中出血量、手术时间和疼痛程度显著优于C组(P<0.01),且出血少于B组(P<0.05)。外周性激素水平与子宫内膜无明显变化(P>0.05)。结论:术前阴道给予20 g/L丙酸睾丸素配伍米索前列醇用于绝经后妇女取IUD,降低了手术难度,减轻了患者的痛苦,安全有效,值得进一步研究与推广应用。Objective： To explore and investigate a new treatment of releasing the risks and pain in removing intrauterine devices （IUD） from postmenopausal women. Methods： A total of 240 postmenopausal women who needed to remove IUD were randomly divided into 3 groups, 80 cases per group. Group A were preoperatively treated with 20 g/L vaginal testosterone propionate cod liver oil ointment （1 g/d） over a 2-week span of period, and vaginal misoprostol 200 μg was one-time used at 2-3 h before operation. Group B were treated with oral estradiol valerate （3 mg/d） from 7 d before operation. The other women （group C, the placebo control） were treated with vaginal cod liver oil ointment （1 g/d） over a 2-week span of period. The degree of cervical relaxation, operational difficulty, blood loss volume, the length of operation time and visual analogue scales （VAS） were evaluated, also the serum estradiol, testosterone and endometrial thickness were measured before and after medication. Results： The degree of cervical relaxation, operational difficulty, blood loss, the length of operation time and VAS in group A were significantly better than those in group C （P〈0.01）, while its blood loss was less than group B （P〈0.05） and there were no significant differences in serum estradiol, testosterone and endometrial thickness before and after medication. Conclusion： Preoperative vaginal testosterone propionate combined with misoprostol would reduce the operational difficulties/risks and release the suffering of patients. The study may represent a safe and effective alternative to remove IUD in postmenopausal women.

关 键 词：绝经 宫内节育器(IUD) 丙酸睾丸素 米索前列醇 

分 类 号：R169.41[医药卫生—公共卫生与预防医学]