归肾丸加减联合T管治疗宫腔粘连术后疗效研究

目的:观察归肾丸加减联合T管用于宫腔粘连术后的临床疗效及其对患者子宫内膜雌激素受体(ER)的影响。方法:回顾性分析92例确诊为中重度宫腔粘连并行宫腔镜下粘连松解术的患者,根据术后预防粘连措施的不同分为三组。观察组31例,T管治疗术后予以归肾丸; 西药组30例,T管治疗术后予以雌孕激素序贯治疗; 球囊组31例,术后予以雌孕激素序贯治疗联合Cook球囊。三组患者均治疗2个月经周期,观察治疗前后宫腔粘连评分、月经量、子宫内膜厚度、子宫内膜ER变化情况、妊娠情况等。结果:观察组总有效率为87.10%、西药组83.33%,球囊组80.65%,三组间总有效率比较,差异无统计学意义(P>0.05)。治疗后三组宫腔粘连评分均较治疗前下降,月经量积分、子宫内膜厚度、子宫内膜ER水平均较治疗前上升,差异有统计学意义(均P<0.05)。观察组与西药组在增加子宫内膜厚度方面均优于球囊组,差异有统计学意义(均P<0.05)。三组在提升月经量积分、子宫内膜ER水平、降低宫腔粘连评分方面比较,差异无统计学意义(均P>0.05)。治疗过程中三组均未出现药物过敏、子宫穿孔、感染等不良反应。结论:归肾丸加减联合T管治疗宫腔粘连术后患者,可有效预防粘连复发,增加月经量,促进子宫内膜增厚,提高子宫内膜ER水平,其总体疗效与雌孕激素序贯治疗联合球囊方案相当,且在增加子宫内膜厚度方面效果更优。

Clinical efficacy study on modified Guishen Wan combined with T tube for postoperative intrauterine adhesions

Objective:To observe clinical efficacy of modified Guishen Wan combined with T tube for postoperative intrauterine adhesion and its effect on endometrial estrogen receptor(ER).Methods:A retrospective analysis of 92 patients diagnosed with moderate to severe intrauterine adhesions underwent hysteroscopic adhesion anlysis was performed,divided into three groups according to different postoperative adhesion prevention measures.31 cases in the observation group were given modified Guishen Wan combined with T tube after operation,30 cases in the western medicine group received estrogen-progestin sequential therapy combined with T tube therapy after operation,31 cases in the balloon group received estrogen-progestin sequential therapy combined with Cook balloon therapy after operation.All the three groups were treated for 2 menstrual cycles.Before and after treatment,the intrauterine adhesion scores,menstrual flow scores,endometrial thickness,endometrial ER levels and pregnancy rate were observed.Results:The total efficiency of the observation group was 87.10%,the western medicine group 83.33%,the balloon group 80.65%,there was no significant difference in the three groups(P>0.05).After treatment,the intrauterine adhesion scores of the three groups were all significantly lower than before,and the menstrual flow scores,endometrial thickness,and endometrial ER levels of the three groups were all significantly higher than before,difference statistically significant(all P<0.05).After treatment,the intrauterine adhesion score of the three groups was decreased compared with that before treatment,the menstrual volume score,endometrial thickness and endometrial ER level were increased compared with those before treatment,differences statistically significant(all P<0.05).The observation group and the western medicine group in increasing endometrial thickness were better than those in the balloon group difference statistically significant(all P<0.05).Improving menstrual volume score,endometrial ER level and reducing uterine adhesion score among the three groups,no significant difference(all P>0.05).No adverse reactions such as drug allergy,uterine perforation and infection occurred in the three groups during the treatment.Conclusion:Guishen Wan combined with T tube in the treatment of patients after intrauterine adhesions can effectively prevent recurrence of adhesions,increase menstrual volume,promote endometrial thickening,and improve endometrial ER level.The overall efficacy of Guishen Wan combined with balloon therapy is comparable to that of progesterone sequential therapy combined with balloon therapy,effect better in increasing endometrial thickness.