| Background and ObjectiveIntrauterine adhesions(IUA),which is also known as Asherman syndrome,refers to the adhesion of uterine muscle wall or cervical canals caused by uterine operation and infection,resulting in the uterine cavity or cervical canal endometrium damage.The clinical manifestations of IUA include recurrent abdominal pain,less menstruation,infertility,premature birth,recurrent miscarriage and so on.Complications such as placental adhesion,placenta implantation and postpartum hemorrhage,which are common in gynecology and having severe damage on reproductive function,can also be caused.At present,the treatment method of IUA is mainly transcervical resection of adhesions(TCRA),but the postoperative recurrence rate of severe uterine adhesion is rather high,almost reaching 62.5%.Therefore,how to reduce the recurrence rate of intrauterine adhesion,restore the patient’s menstruation and fertility and improve the pregnancy outcome,is an urgent problem to be solved.At present,artificial cycle therapy based on the estrogen has been widely used in the treatment of IUA;meanwhile,auxiliary physical barrier method adopted with the assistance of drug therapy is commonly used to prevent the recurrence of adhesion.In view of the long treatment period and high dosage of the drug for treatment,the drug safety and efficacy should be taken into consideration in the selection of estrogen preparations.This research project was aimed to observe the percutaneous estrogen preparations in the role of serum estradiol level,endometrial repair,uterine cavity recovery and menstrual improvement,pregnancy rate and the side effect of drug after the operation,comparing with the classical oral estrogen preparation and analyzing the clinical value of the two kinds of therapies.Furthermore,this research result can provide guidance for the clinical medication.Materials and Methods 1 MaterialsDuring Desember 2016--Desember 2017,patients considered " less menstruation,amenorrhea,infertility,abdominal pain" as chief complaints,seeking treatment in the Second Affiliated Hospital of Zhengzhou University.About 85 patients were diagnosed as IUA by hysteroscopy with the age range from 24-38 and an average age of 30.81±3.62.According to the random number based on the admission time,the patients were randomly divided into the percutaneous dose group(42 cases)and the oral dose group(43 cases).2 Methods 2.1 Medication methods: All patients began to use the equivalent estrogens on the third day of menstruation with a total dose of 4mg/d for 28 days,and then use the progesterone tablets with a total dose of 20mg/d for subsequently 7days.The estrogens was used in the skin group,and the oral dose group was selected for the Progynova.2.2 Observation: All patients need to be tested the level of serum estradiol on the third day and sixth day after menstruation and calculate the average value of serum estradiol.Endometrial thickness measured by ultrasound in tenth to fifteenth days after menstrual cycle and before the operation.3 months after the operation,all patients were reexamined by hysteroscopy,follw up and record the uterine cavity shape,the recorvory of menstruation and endometrial thickness;meanwhile,the pregnancies and side effect of drug were also tested.3 Statistic AnalysisThe data was analyzed using SPSS 23.0 software.Measurement datas were described with the mean and standard deviation.To use paired t test analysed the treatment outcome in each group and used chi-square test to analyse the comparison of rate.There were significant differences as P<0.05.The test level is α=0.05.Results 1.Serum estradiol level and endometrial thicknessComparison of serum estradiol(77.40±33.26 pg/ml vs 78.19±21.74 pg/ml)before the operation in two groups showed no significant differences(P>0.05);while the comparison of serum estradiol after the operation between two groups showed significant differences(P<0.05);The serum estradiol levels were significantly higher than those in the oral group after treatment with percutaneous dose group(254.76±64.70 pg/ml vs 176.07±34.34 pg/ml),and the difference was statistically significant(P<0.05).2.Endometrial thicknessComparison of endometrial thickness(4.42±0.72 mm vs 4.34±0.62mm)before the operation in two groups showed no significant differences(P>0.05);while the endometrial thickness after the operation between two groups showed significant differences(P<0.05);The endometrial thickness changes were significantly higher than those in the oral group after treatment with percutaneous dose group(6.94±0.65 mm vs 6.24±0.752mm),and the difference was statistically significant(P<0.05).3.Menstrual improvement and uterine cavity recoveryThe effective rate of uterine cavity recovery of the percutaneous dose group and oral dose group was respectively 83.33%、72.09%.The difference between the two groups were no statistically significant(P>0.05).The menstrual changes of percutaneous dose group and oral dose group were respectively 78.57%、72.09%,There were no significant differences among them(P>0.05).4.Pregnancy rateAfter follow-up,there were 23(54.76 %)pregnancies in the percutaneous dose group and 20(46.51 %)patients in the oral dose group.There were no significant differences among them(P>0.05).5.Side effect of drugGastric discomfort was found in 1 case(2.38 %)of the percutaneous group,and 4 cases(9.30 %)in the oral group showed stomach discomfort,and 6(13.95 %)cases showed double lactic acid distension,and the difference between the two groups was statistically significant(P>0.05).Conclusions1.The estrogen in the percutaneous dose group can effectively increase the uterine endometrium and promotes endometrial repair and has better curative effect than oral dose group.2.Adopting the percutaneous estrogen therapy can effectively promote normal menstruation and restoration of uterine cavity.3.The percutaneous estrogen preparation has low side effect and high security,which is a kind of treatment with high efficiency and low side effects.It should be popularized in clinical medication. |
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