| Background and ObjectiveIntrauterine adhesions(IUA)is caused by several reasons such as mechanical injury or infection of basal layer of endometrium,leading to adhesions of the wall of the uterus,cervix,even the whole uterine cavity,causing hypomenorrhea ?amenorrhoea,infertility,recurrent spontaneous abortion and periodic hypogastralgia and so on.Hysteroscopy has become the diagnostic gold standard of IUA,hysteroscopic intrauterine adhesions(TCRA)is the standard surgical treatment of intrauterine adhesions.However,the study showed that the intrauterine readhesion could reach 3.1%-23.5%,and severe adhesion was 62.5% after TCRA.Although there is no conclusive evidence to support the effectiveness of estrogen application,it is recommended that estrogen should be used to promote endometrial growth for postoperative intrauterine adhesions.In 2015,the Chinese Medical Association "expert consensus on clinical diagnosis and treatment of intrauterine adhesions" recommended that estradiol valerate 2-4mg/d or equivalent estrogen should be used after operation to prevent recurrence of intrauterine adhesions.However,there are still controversies about the types of estrogen,the route of administration,and the time of treatment.At present,the main routes of estrogen administration are oral,vaginal and transdermal administration.The aim of this study is to investigate the prognosis of patients with severe intrauterine adhesions after oral administration,vaginal administration and transdermal administration,to find a better way of estrogen administration.ObjectiveAccording to observation the endometrium thickness.menstrual recovery uterine cavity morphology.pregnancy.adverse reactions of postoperative severe intrauterine adhesions patients separately using oral estrogen,vaginal estrogen and transdermal estrogen,we expect to find the best administration way of estrogen.Materials and methodsBetween January,2015,and December,2016,90 patients who was diagnosed with severe intrauterine adhesions are randomly divided into A group of 30 cases,B group of 30 cases,C group of 30 cases.all patients underwent TCRA by a treatment group experienced physicians,placing Foley balloon in the operation.all patients use artificial cycle,A group patients receive oral estradiol valerate(bu jia le 4mg/d);B group patients receive vaginal estrogen of 17 beta estradiol / estradiol dydrogesterone(fen ma tong)1mg/d,only using the white tablets;C group receive the transdermal estradiol gel 5.0mg/ day;all patients treat tuo cycles for 21 days as an artificial cycle.All patients reexamine hysteroscopy for 3-7 days in a clean period of menstruation.groupA,groupB and grouC cases be compared with the endometrium thickness.menstrual recovery uterine cavity morphology.pregnancy.adverse reactions.Group A and group B compare with serum concentrations of estrogen after first,second,and third weeks after operation.Results1.General dataA group: 30 cases,average 31.90 + 5.37year;B group: 30 cases,average 29.93 + 4.63year;C group: 30 cases,average 32.37 + 5.15 years;Body mass index(BMI)were 22.67 + 2.43kg/m2,22.68 + 2.53kg/m2,22.74 + 2.73kg/m2,;The menstrual cycle were 27.2 + 4.66 days,6.17 days,28.5 + 29.3 + 5.57 days,the 3 groups patients have no statistical significance with age,body mass index and menstrual cycle difference(P>0.05),.The number of pregnancy and abortion patients using Kruskal-Wallis rank sum test,the difference was not statistically significant.2.menstrual recoveryA group patients who have normal menstruation menstruation,ineffective menstruation is respectively 10,13,7;B group patients who have normal menstruation,improved menstruation,ineffective menstruation is respectively 14,8,8;Cgroup patients who have normal menstruation,improved menstru-ation,ineffective menstruation is respectively 12,11,7,comparing with the Kruskal-Wallis rank test.the difference was not statistically significant3.endometriumAverage endometrial thickness before treatment is respectively were 3.19 + 0.97 mm,3.71 + 1.05 mm,3.91 + 1.11 mm,;Endometrial thickness after second artificial cycle estrogen respectively was 6.21 + 1.63 mm,5.94 + 1.73 mm,6.36 + 1.43mm;Endometrial thickness in 3 groups of patients before and after treatment compare with paired t test,the difference was statistically significant.4.Uterine cavity form gradeA group patients who's uterine cavity are cured,improved,invalid is respectively 10,6,14;B group patients who's uterine cavity are cured,improved,invalid is respectively 9,11,10;C group patients who's uterine cavity are cured,improved,invalid is respectively 10,11,9;the effect of the 3 groups using Kruskal-Wallis rank sum test,the difference was not statistically significant5.Pregnancy rateThree groups of patients with fertility requirements were 28,29,29 cases.3 groups of patients with fertility requirements accounte for the proportion of all patients 93.33%,96.67%,96.67%;Pregnancy cases after one year follow-up are 8,9 and 10 cases,the pregnancy rate was: 28.57%,31.03%,34.48%;6.adverse reactionsThe adverse reactions after 3 months ] follow-up with 3 groups of patients in medication during :A group,1cases of breast pain,1 cases of vaginitis,3 cases of gastrointestinal discomfort;the other 0 cases;B group : 2 cases of breast pain,3 cases of vaginitis,gastrointestinal discomfort in 0 cases,the other 1 cases,group C;: breast pain in 0 cases,0 cases of vaginitis,gastrointestinal discomfort in 2 cases,3 cases of skin allergy;7.estrogen concentrationThe average concentration of estrogen of A group and B group of patients before treatment are 52.86 + 18.40pg/ml,56.48 + 24.80pg/ml;concentrations for first weeks artificial cycle therapy were 152.46 + 39.78pg/ ml 978.07 + 395.40pg/ml,B group estrogen concentrations is higher than A group;third weeks estrogen concentrations were 149.88 + 48.01pg/ml,1265.19 + 286.03pg/ml;conclusion1.the oral administration of estrogen,vaginal administration and skin adminis tration have no significant difference in the prognosis of patients with severe intrauterine adhesions.2.The patients can choose the oral route of estrogen according to their own acceptance,the vaginal pathway,the older,(and)or the liver and kidney function,the blood clotting function,the blood lipid,and the digestive tract dysfunction may consider using the transdermal pathway and vaginal pathway.3.The prognosis of the patients with severe intrauterine adhesions are not dependent on the blood concentration of estrogen. |
PDF Full Text Request