促性腺激素释放激素类似物联合小剂量雌激素预防中、重度宫腔黏连复发的疗效分析  

Efficacy analysis of gonadotropin releasing hormone analogue combined with low dosage estrogen for preventing recurrence of moderate or severe intrauterine adhesion

作　　者：程丹[1] 杨菁[1] 李洁[1] 闫文杰[1] 罗金[1] 刘倩[1] 

机构地区：[1]武汉大学人民医院生殖医学中心、湖北省辅助生殖与胚胎发育医学临床研究中心,430060

出　　处：《中华妇幼临床医学杂志（电子版）》2017年第4期432-437,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：湖北省卫生计生委青年科技人才项目(WJ2015Q013)~~

摘　　要：目的探讨促性腺激素释放激素类似物(GnRHa)联合小剂量雌激素,预防中、重度宫腔黏连(IUA)复发的疗效。方法选取2015年1月至6月,于在武汉大学人民医院生殖医学中心接受宫腔镜下宫腔黏连分离术(TCRA)治疗的115例中、重度IUA患者为研究对象。根据患者于TCRA治疗后,接受的预防IUA复发措施,将其分为GnRHa组(n=48),患者于TCRA治疗后,接受GnRHa联合口服戊酸雌二醇片2mg/d×90d治疗预防IUA复发;对照组(n=67),患者于TCRA治疗后,接受戊酸雌二醇片6~9mg/d与黄体酮软胶囊100mg/d,序贯治疗90d预防IUA复发。对所有受试者于TCRA治疗后3个月进行宫腔镜复查,评估2组患者TCRA后预防IUA复发治疗有效率;并于TCRA治疗后随访6个月,观察2组患者接受预防IUA复发治疗后,月经恢复情况与子宫内膜厚度。统计学比较2组患者TCRA后接受预防IUA复发的治疗有效率、月经量改善率、子宫内膜厚度及不良反应率。本研究遵循的程序,获得武汉大学人民医院医学伦理委员会批准,并与所有受试者签署临床研究知情同意书。结果(1)2组IUA患者的年龄、人体质量指数(BMI)、病程,以及TCRA治疗前月经过少与闭经构成比与中、重度IUA构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。(2)GnRHa组患者TCRA后接受预防IUA复发的治疗有效率为87.5%(42/48),显著高于对照组的61.2%(41/67),二者比较,差异有统计学意义(χ~2=9.636,P=0.002)。GnRHa组患者TCRA后接受预防IUA复发治疗的月经量改善率为75.0%(36/48),对照组为67.2%(45/67),二者比较,差异无统计学意义(χ~2=0.825,P=0.364)。2组患者TCRA后接受预防IUA复发治疗后的子宫内膜厚度比较,差异无统计学意义(t=1.278,P=0.204)。(3)GnRHa组患者TCRA后接受预防IUA复发治疗的不良反应率为10.4%(5/48),显著低于对照组的26.9%(18/67),二者比较,差异有统计学意义(χ~2=4.729,P=0.030)。结论中、重度IUA患者于TCRA治疗后,采取GnRHObjective To evaluate the efficacy of gonadotropin releasing hormone analogue（GnRHa）combined with low dosage estradiol valerate for preventing the recurrence of moderate or severe intrauterine adhesion（IUA）after hysteroscopic adhesiolysis.Methods A total of 115 patients with moderate or severe IUA who underwent transcervical resection of adhesions（TCRA）by hysteroscopy treatment at the Center of Reproductive Medicine,Renmin Hospital of Wuhan University,from January to June 2015 were selected as research subjects.And patients were divided into GnRHa group（n=48）and control group（n=67）according to the prevention method of IUA recurrence after TCRA.GnRHa group patients were given GnRHa and low dosage estradiol valerate tablets（2 mg/d×90d）after TCRA.And control group patients were given high dosage estradiol valerate tablets（6-9mg/d）and progesterone soft capsules 100 mg/d for consecutive treatment with 90 d.Second-look hysteroscopic examination was performed on all patients at 3 months after TCRA treatment to evaluate the effective rate of prevention of IUA recurrence in two groups.And 6-month follow-up after TCRA treatment was taken to investigate menstrual recovery and endometrial thickness.Statistical methods were used to compare the effective rates of prevention of IUA recurrence,improvement rates of menstrual flow,thickness of endometrium and adverse reactions rates of two groups after TCRA treatment and receiving the prevention method of IUA recurrence.The study was approved by the Medical Ethics Committee of Renmin Hospital of Wuhan University.All the patients signed the written informed consent forms.Results（1）There were no significant differences between GnRHa group and control group in the age,body mass index（BMI）,course of disease,the ratio of menstruation to amenorrhea and the ratio of moderate or severe IUA before TCRA treatment（P〈0.05）.（2）The effective rate of prevention of IUA recurrence after TCRA treatment was 87.5%（42/48）in GnRHa group,which was signi

关 键 词：宫腔黏连 促性腺激素释放激素类似物 戊酸雌二醇 分离术 复发 治疗效果 妇女 

分 类 号：R713.4[医药卫生—妇产科学]