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目的观察雌孕激素联合透明质酸钠凝胶辅助治疗宫腔镜下重度宫腔粘连分离术患者的效果。方法将90例进行宫腔粘连分离术治疗的患者随机分为观察组和对照组,每组45例。对照组患者给予宫腔镜下宫腔粘连分离术联合透明质酸钠凝胶治疗,观察组患者则在上述治疗的基础上给予雌孕激素,比较2组患者的临床疗效、经期时间、月经量、妊娠结局及粘连复发情况,并采用美国生育学会提出的女性附件粘连评分系统(AFS评分)对宫腔粘连情况进行评分。结果观察组总有效率为95.56%高于对照组的80.00%,差异有统计学意义(χ2=5.075,P<0.05)。疗程结束后,观察组经期时间、月经量、AFS评分均优于对照组,差异均有统计学意义(P<0.05)。观察组患者不良妊娠发生率为4.44%明显低于对照组的17.78%,差异有统计学意义(χ2=4.05,P<0.05)。观察组患者粘连复发率为2.22%明显低于对照组的15.56%,差异有统计学意义(χ2=4.939,P<0.05)。结论雌孕激素联合透明质酸钠凝胶辅助治疗宫腔镜下宫腔粘连分离术患者效果确切,优于术后单纯使用透明质酸钠凝胶者,妊娠结局明显得到改善,并且能够降低复发率,值得在临床上推广应用。
Objective To observe the effect of estrogen and progesterone combined with sodium hyaluronate gel in the treatment of severe hysteroscopic adhesions in hysteroscopic patients. Methods Totally 90 patients who underwent intrauterine adhesions separation were randomly divided into observation group and control group, with 45 cases in each group. Patients in the control group were treated with hysteroscopic intrauterine adhesions and sodium hyaluronate gel treatment. Patients in the observation group were given estrogen and progesterone on the basis of the above treatment. The clinical efficacy, menstrual period, menstrual flow , Pregnancy outcome and adhesion recurrence, and using the American Fertility Society’s Female Attachment Adhesion Scoring System (AFS score) on intrauterine adhesions were scored. Results The total effective rate in observation group was 95.56% higher than that in control group (80.00%), the difference was statistically significant (χ2 = 5.075, P <0.05). After the end of treatment, the observation group menstrual time, menstrual flow, AFS score were better than the control group, the difference was statistically significant (P <0.05). The incidence of adverse pregnancy in observation group was 4.44%, which was significantly lower than that in control group (χ2 = 4.05, P <0.05). The recurrence rate of adhesion in observation group was significantly lower than that of control group (2.22% vs 15.56%, χ2 = 4.939, P <0.05). Conclusion The combination of estrogen and progesterone plus hyaluronic acid gel in the treatment of intrauterine adhesions in hysteroscopic surgery is better than that of sodium hyaluronate gel after operation. The outcome of pregnancy is obviously improved and the relapse rate can be reduced Rate, it is worth to promote the clinical application.