雌激素不同给药途径对宫腔重度粘连术后预后的影响  

Effect of Different Estrogen Administration Pathway on Prognosis of Patients after Surgery for Severe Intra Uterine Adhesion

作　　者：任春盈 任琛琛[1] 杨立[1] 王朝昕 朱远航[1] 陈飞 贺雯 赵亚琼 潘学景 魏心怡 REN Chunying;REN Chenchen;YANG LI(Third Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450000,China)

机构地区：[1]郑州大学第三附属医院,河南郑州450000

出　　处：《实用妇产科杂志》2018年第12期943-947,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:比较雌激素不同给药途径对宫腔重度粘连术后预后的影响,指导临床用药。方法:选择2015年1月至2017年1月在我院宫腔镜诊治中心就诊的90例宫腔重度粘连行粘连分离手术患者作为研究对象,根据雌激素不同给药途径分为口服组30例、阴道组30例、皮肤组30例,口服组给予戊酸雌二醇4 mg/d口服,阴道组17-β雌二醇1 mg/d阴道给药,皮肤组经皮肤给予雌二醇缓释凝胶5 mg/d,均21天为一个人工周期。用药后5天加服黄体酮胶囊200 mg/d,应用2个人工周期后复查宫腔镜,比较术后雌激素血药浓度、月经恢复、内膜厚度、宫腔形态、妊娠结局及不良反应发生情况。结果:术前雌激素血药浓度口服组(193.47±67.34 pmol/L)、阴道组(206.72±90.77 pmol/L)及皮肤组(211.62±82.24 pmol/L)比较差异无统计学意义(P>0.05);术后第1周雌激素血药浓度口服组(558.00±145.59 pmol/L)、阴道组(3579.74±1447.16 pmol/L)、皮肤组(614.11±154.52 pmol/L)比较差异有统计学意义(P<0.05);术后第3周雌激素血药浓度口服组(548.56±175.72 pmol/L)、阴道组(4630.60±1046.87 pmol/L)、皮肤组(603.46±194.24 pmol/L)比较差异有统计学意义(P<0.05)。术后第1周、第3周阴道组雌激素血药浓度均高于口服组、皮肤组(P<0.05)。3组术后月经恢复、内膜厚度、宫腔形态、妊娠结局及不良反应情况间比较差异无统计学意义(P>0.05)。结论:阴道用雌激素血药浓度高于口服和皮肤用药途径。雌激素不同给药途径对宫腔重度粘连术后预后无明显影响。Objective:To compare the effect of different routes of administration of estrogen on prognosis of patients after surgery for severe intrauterine adhesions.To provide evidence for clinical medication.Methods :90 cases of patients with severe intrauterine adhesions in the diagnosis and treatment center of hysteroscopy in our hospital between Jan.2015 and Jan.2017 were enrolled.According to the different ways of estrogen administration,30 cases were divided into oral group,30 cases intovaginal group and 30 casesinto skin group.The oral group was given estradiol valerate 4 mg/d.The vagina group was administrated with 17-beta estradiol 1 mg/d.The skin group was administreated with estradiol sustained release gel 5 mg/d.21 days were counted as an artificial cycle.Progesterone capsule(200 mg/d)was prescribed 5 days after administration of estrogen.Hysteroscope was performed after two artificial cycles.The postoperative estrogen concentration,menstrual recovery,endometrium thickness,uterine cavity morphology,pregnancy outcome and side effects were compared.Results:There was no significant difference in preoperative serum estrogen concentration between oral group (193.47±67.34 pmol/L),vaginal group (206.72±90.77 pmol/L)and skin group(211.62±82.24 pmol/L)(P>0.05).There were significant differences in estrogen serum concentration one weekafter operation between oral group (558.00±145.59 pmol/L),vaginal group (3579.74 ±1447.16 pmol/L)and the skin group (614.11±154.52 pmol/L)(P<0.05 ).There were significant differences in estrogen serum concentration three weeks after operation between oral group (548.56±175.72 pmol/L),vaginal group (4630.60±1046.87 pmol/L)and the skin group(603.46±194.24 pmol/L)(P<0,05).The blood concentration of estrogen in vaginal group after one and three weeks was higher than that in oral group(P<0.05).There were no significant differences in menstrual recovery,intimal thickness,uterine cavity shape,pregnancy outcome and adverse reactions among the three groups (P>0.05).Conclusions:The plasma co

关 键 词：宫腔重度粘连 戊酸雌二醇 17-Β雌二醇 雌二醇缓释凝胶 

分 类 号：R713.4[医药卫生—妇产科学]