宫腔镜宫腔粘连松解术后应用雌激素对粘连复发和生育结局的影响:前瞻性随机对照研究  

Effect of Estrogen on Recurrence of Adhesion and Reproductive Outcome After Hysteroscopic Intrauterine Adhesiolysis: a Prospective Randomized Controlled Trial

作　　者：杨玲玲[1] 马宁[1] 宋冬梅[1] 周巧云[1] 郭艳[1] 李天照[1] Yang Lingling;Ma Ning;Song Dongmei(Department of Hysteroscopic Center,Fuxing Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属复兴医院宫腔镜中心,北京100045

出　　处：《中国微创外科杂志》2023年第3期197-202,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨宫腔镜子宫内膜粘连松解术后应用雌激素预防粘连复发和生育结局的作用。方法选择2018年8月~2021年5月因中重度宫腔粘连[美国生殖协会(American Fertility Society,AFS)评分7~12分]于我科行宫腔镜下宫腔粘连松解术,密闭信封法随机分组,试验组术后口服雌孕激素序贯治疗(戊酸雌二醇4 mg每日2次共21天,地屈孕酮10 mg每日2次共7天)2个月,对照组不给药。术后4周、8周复查宫腔镜,术后3个月试孕,随访24个月。结果共91例完成研究,其中试验组46例,对照组45例。2组术后4周、8周宫腔镜检查的粘连复发率和AFS评分差异均无统计学意义(P>0.05)。2组术后妊娠率[34.8%(16/46)vs.33.3%(15/45),P=0.884]和活产率[23.9%(11/46)vs.22.2%(10/45),P=0.848]差异均无统计学意义。结论对于中重度宫腔粘连,宫腔镜术后应用雌激素并未改善粘连复发及妊娠结局。Objective To explore the role of estrogen in preventing recurrence of adhesion and influencing reproductive outcome after hysteroscopic adhesiolysis of intrauterine adhesion.Methods From August 2018 to May 2021,hysteroscopic adhesiolysis was performed in our department due to moderate and severe intrauterine adhesions[American Fertility Society(AFS)score:7-12 points].The patients were randomly divided into two groups by closed envelope method.The experimental group received oral estrogen and progesterone sequential treatment(estradiol valerate 4 mg twice daily for 21 days,and dydrogesterone 10 mg twice daily for 7 days)for 2 months after operation,while the control group was not given drugs.Hysteroscopy was re-examined at 4 and 8 weeks after operation,and pregnancy was attempted after 3 months after operation.The follow-up period was 24 months.Results A total of 91 cases completed the study,including 46 cases in the experimental group and 45 cases in the control group.There were no significant differences between the two groups in the adhesion recurrence rate and AFS score on hysteroscopy at 4 and 8 weeks after operation(P>0.05).There were no significant differences between the two groups in pregnancy rate[34.8%(16/46)vs.33.3%(15/45),P=0.884]and live birth rate[23.9%(11/46)vs.22.2%(10/45),P=0.848].Conclusion For moderate and severe intrauterine adhesion,estrogen treatment after hysteroscopy does not improve the recurrence of adhesion and pregnancy outcome.

关 键 词：雌激素 宫腔粘连 妊娠结局 随机对照研究 

分 类 号：R713.4[医药卫生—妇产科学]