| Objective: To compare the effects of estradiol valerate combined with intrauterine intrauterine device(IUD)and IUD on the recurrence of TCRA after uterine cavity adhesion(TCRA)after hysteroscopic intrauterine adhesions decomposition(TCRA),and to observe the effects of these schemes on menstrual improvement,uterine recovery and pregnancy conditions after the operation.Objective to investigate the clinical value of estradiol valerate combined with IUD in preventing the recurrence of adhesions after TCRA.Materials and methods: the subjects selected 110 patients with intrauterine adhesions treated in the affiliated hospital of medical school of ningbo university in June 2015 ~November2016,,and divided them into 2 groups of estrogen +IUD group and IUD group according to random numbers,55 cases in each group.The average age of the estrogen +IUD group(32.72 + 3.65),the pregnancy(2.78 + 1.77)times,(0.18 + 0.29)times,the frequency of uterine cavity operation(1.61 + 1.08)times,mild adhesion 21 cases,moderate adhesion 21 cases,severe adhesion 13 cases,menstrual oligoedema 44 cases,amenorrhea 11 cases.The average age of group IUD(31.63 + 3.74),pregnancy(2.65 + 1.70)times,(0.16 + 0.24)times,uterine cavity operation times(1.58 + 1.22)times,mild adhesion 25 cases,moderate adhesion 19 cases,severe adhesion 11 cases,menopause 47 cases,amenorrhea 8 cases.There was no significant difference in general data between the two groups(P>0.05).In the group of estrogen +IUD,IUD was placed immediately after operation,and estradiol valerate was taken orally with estradiol valerate,and group IUD was placed only after IUD,and no estradiol valerate was given.After the operation,two groups of patients were followed up,and 3 months after the operation,the hysteroscopy was reviewed.The changes of the uterine cavity shape,the thickness and volume of the endometrium,the recovery of menstruation,and the pregnancy of the two groups were compared.The independent sample t test and chi square test were used in this study.The difference between P<0.05 and chi square test was statistically significant.Results: 1.3 months after the operation,there were 26 cases of normal menstruation in the estrogen +IUD group,24 cases improved,5 cases without improvement,the total effective rate of menstrual improvement was 90.91%(50/55);in group IUD,18 cases were restored to normal menstruation,20 cases were improved,17 cases were not improved,and the total effective rate of menstrual improvement was 69.09%(38/55).The total effective rate of menstrual improvement in estrogen group +IUD was significantly higher than that in group IUD,and the difference between the two groups was statistically significant(P<0.05).2.3 months after the operation,two groups of patients were rechecked by hysteroscopy.There were 2 cases of mild adhesion in the estrogen +IUD group,1 cases of moderate adhesion,no severe adhesion and 5.45% recurrence rate(3/55),8 cases of mild adhesion in group IUD,7 cases of moderate adhesion,1 cases of severe adhesion,and 29.09%(16/55).The recurrence rate of adhesions in the estrogen group +IUD was significantly lower than that in the IUD group,and the difference between the two groups was statistically significant(P<0.05).3.3 months after operation,the thickness of endometrium in the two groups was thicker than that before operation(P<0.05),and the volume of uterus increased significantly(P<0.05).The endometrial thickness and uterine volume at 3 months after operation in estrogen +IUD group were significantly greater than that in group IUD(P<0.05).4.Two groups of patients were followed up for a long time without any loss of follow-up.The follow-up time was 10~24 months.Follow up was mainly followed by telephone follow-up.Some patients were followed up for outpatient visits to understand postoperative natural pregnancy or artificial assisted pregnancy.There were 49 cases of fertility requirement in estrogen group +IUD,of which 31 cases were successful pregnancies,the successful pregnancy rate was 63.27%(31/49),and the live rate was 90.32%(28/31).In group IUD,there were 51 cases with fertility requirements,of which 22 cases were successful pregnancies,the successful pregnancy rate was 43.14%(22/51),and the live rate was 45.45%(10/22).The successful pregnancy rate and live birth rate of estrogen group +IUD were significantly higher than those of IUD group.The difference between the two groups was statistically significant(P<0.05).5.There were no significant changes in AST,ALT,TC and TG in the estrogen +IUD group before and 3 months after operation,and there was no significant difference in the liver function and blood lipid indexes before and after the treatment(P>0.05).Conclusion: after TCRA,the treatment with estradiol valerate combined with IUD can effectively reduce the recurrence rate of postoperative adhesion,and can effectively improve the patient's menstrual situation and promote the postoperative pregnancy of the patients with reproductive demand.The prognosis of the patients is obviously improved,the clinical effect is satisfactory,and the value should be further promoted and used in clinical practice. |
PDF Full Text Request