|
|
|
| Effects of Intrauterine Device Combined with Different Doses of Estrogen on Uterine Adhesion, Menstrual Recovery and Pregnancy Rate after Laparoscopic Intrauterine Adhesions Separation |
| YE Feng-ru, HUANG Yu-ling, PENG Hai-yan, et al |
| Department of Obstetrics and Gynecology, Dalang Hospital of Dongguan, Dongguan, Guangdong 523770 |
|
|
|
Abstract 【Objective】To investigate the effects of intrauterine device(IUD) combined with different doses of estrogen on intrauterine adhesion (IUA), menstrual recovery and pregnancy rate after laparoscopic intrauterine adhesions separation by trans-cervical resection of adhesion (TCRA).【Methods】The clinical data of 60 patients with intrauterine adhesions in our hospital from January 2014 to January 2017 were analyzed retrospectively. All patients underwent trans-cervical resection of adhesion at 3~7 days after menstruation, and were given O-type metal IUD combined with estrogen after operation. According to the different doses of estrogen received, patients were divided into the low-dose group (3 mg/d) with 25 cases, the middle-dose group (6mg/d) with 19 cases, and the high-dose group (9mg/d) with 16 cases. Patients were followed up with three months after operation, and changes in endometrial thickness, incidence of intrauterine adhesions and recovery of menstruation were examined. Based on the requirements of the American Fertility Association (AFS), the intrauterine adhesions score was determined. For patients who had fertility requirements, conditions for pregnancy within 1 year after operation were noted. 【Results】The incidence of intrauterine re-adhesions in the low-dose group was less than that in the middle-and high-dose groups, and the percentile of menstruation recovery was higher than that in the middle-and high-groups. The differences were statistically significant (P<0.05). After treatment, the AFS score in the low-dose group decreased more obviously than that in the middle- and high-dose groups, and the difference was statistically significant (P<0.05). The thickness of the endometrium after treatment in the low-dose group increased more obviously than that in the middle- and high-dose groups and the difference was statistically significant (P<0.05). The pregnancy rates within 1 year after operation in the three groups were 54.5% (6/11), 50% (8/16), and 55.6% (5/9) respectively but the difference was not statistically significant (P>0.05).【Conclusion】Uterine cavity indwelling IUD combined with low dose estrogen (3mg/d) is conducive to the recovery of patients with intrauterine adhesions. It can reduce intrauterine re-adhesion, improve menstrual recovery, and have no significant effect on postoperative pregnancy rate.
|
|
Received: 05 December 2017
|
|
|
|
|
|
[1] 夏恩兰. 宫腔镜手术并发症诊治现状及展望[J].中国实用妇科与产科杂志, 2015,31(5):369-373.
[2] 李鹰, 郭俭. 术泰舒联合宫内节育器、雌孕激素序贯治疗预防宫腔镜术后宫腔粘连的疗效观察[J].医学临床研究, 2018, 35(1):131-133.
[3] 苏瑞金. 宫腔粘连分离术后放置充水球囊预防再粘连的疗效观察[J].中国妇幼保健, 2014,29 (18) : 3008-3010.
[4] 罗成燕,邱江南,杨一君.不同剂量雌激素对重度宫腔黏连术后复发及月经的影响[J].中华妇幼临床医学杂志(电子版),2016,12(5):558-565.
[5] Roy KK, Baruah J, Sharma JB, et al.Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome[J].Arch Gynecol Obstet,2010, 281(2): 355-361.
[6] 张冬梅, 何援利, 蔡慧华,等. 宫腔粘连患者子宫内膜雌、孕激素受体的表达及意义[J].实用医学杂志, 2017, 33(5):843-844.
[7] 陈海燕.子宫内膜组织ER、TGF-β1水平与宫腔粘连发病机制的关系研究[J].河北医药,2016,38(2):170-172.
[8] 杨欢, 常亚杰, 陈玉清. 重度宫腔粘连子宫内膜修复中微血管密度及VEGF的表达及其临床意义[J].新医学, 2016, 47(10):671-675.
[9] 吴岭, 崔超美. 宫腔粘连术后使用不同剂量戊酸雌二醇联合宫内节育器预防再粘连的临床疗效观察[J].中国社区医师, 2015,31(16):33-34.
[10] 王晶, 陈滢, 童明. 不同剂量戊酸雌二醇预防宫腔粘连48例临床效果分析[J].华南国防医学杂志, 2014,28(4):312-313. |
|
|
|
2018, Vol. 35 
