GnRH-a治疗对中、重度宫腔粘连手术结局的影响  

Effects of GnRH-agonist on Patients Receiving Resection of Moderate-to-severe Intrauterine Adhesion

作　　者：刘芸[1] 段华[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,北京100006

出　　处：《中国微创外科杂志》2014年第6期522-525,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：国家临床重点专科建设项目(妇科);北京市医院管理局临床医学发展专项(项目编号:ZY201406);生殖与生育重大疾病诊治的规范化与推广(项目编号:201002013)

摘　　要：目的探讨促性腺激素释放激素激动剂（GnRH-a）对宫腔镜下宫腔粘连分离术（transcevical resection of adhesions，TCRA）后结局的影响。方法选取2008年1月～2013年6月我院妇科微创中心由同一医生施行TCRA的27例中、重宫腔粘连（中度19例，重度8例）合并Ⅲ-Ⅳ期子宫内膜异位症作为研究组，TCRA术后放置宫内节育器（IUD），GnRH—a治疗3个周期；同期接受TCRA术后人工周期药物治疗3个周期，但未进行GnRH—a治疗的94例宫腔粘连（中度66例，重度28例）作为对照组。TCRA术后3个月宫腔镜检查评估术后效果，同时检测研究组GnRH-a治疗3个月后雌二醇（E2）水平和对照组人工周期3个月后月经第2天E2水平。结果研究组术后1个月内3例（11．1％）盆腔炎症，对照组5例（5．3％），2组比较差异无统计学意义（χ2=0．395，P=0．530），8例经抗炎治疗2周后治愈。TCRA术后3个月宫腔镜检查：研究组治疗有效率77．8％（中度16例，重度5例），对照组治疗有效率75．5％（中度52例，重度19例），2组比较无统计学差异（Z=-0．095，P：0．924）。研究组GnRH-a3个月后E2为（19．12±8．53）ps／ml，对照组E2为（163．72±77．69）ps／ml，2组比较有统计学差异（t=-9．626，P=0．000）。结论GnRH-a造成的低雌激素状态不影响TCRA的术后效果。Objective To explore the effects of GnRH-agonist on patients receiving transcervical resection of adhesions （TCRA）. Methods A total of 27 cases of intrauterine adhensions （moderate, 19 cases; severe, 8 eases） combined with stage III or IV endometriosis, receiving TCRA by the same doctor, from January 2008 to June 2013 in this hospital was enrolled as the study group. After the TCRA, an interuterine device （IUD） was put in and 3 cycles of GnRH-agonist medication were given. Another group of 94 cases of intrauterine adhensions （moderate, 66 cases; severe, 28 cases） during the same period, which received TCRA and artificial cycle therapy but no GnRH-agonist medication, was selected as the control group. All the patients received 3 months follow-up and had the second hysteroscopy to evaluate the uterine shape and the serum E2 at the second day of the fourth cycle. Results The total effective rate was 77.8% in the study group （moderate, 16 cases; severe, 5 cases） and 75.5% in the control group （ moderate, 52 cases; severe, 19 cases）. There was no significant difference between the two groups （Z = -0. 095, P = 0. 924）. The serum E2 was significant lower in the study group as compared with the control group [ （19.12 ± 8.53） pg/m] vs. （163.72 ± 77.69） pg/ml, t = - 9. 626, P = 0. 0003- Three cases in the study group （ 11.1% ） and 5 cases in the control group （5.3%） received antibiotic medication for pelvic inflammation, and there was no statistical difference between the two groups （X2 = 0. 395, P = 0. 530）. Conclusion Low level of E2 induced by GnRH-agonist does not influence the result of the TCRA, but the abnormal uterine bleeding when using GnRH-agonist may increase the risk of pelvic inflammation after TCRA.

关 键 词：宫腔粘连 子宫内膜异位症 促性腺激素释放激素激动剂 宫内节育器 雌激素 

分 类 号：R711.71[医药卫生—妇产科学]