Casadei Luisa, Piccolo Eleonora, Manicuti Claudia, Cardinale Silvia, Collamarini Matteo, Piccione Emilio
Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
Obstet Gynecol Sci. 2016 May;59(3):220-6. doi: 10.5468/ogs.2016.59.3.220. Epub 2016 May 13.
To assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women.
In this observational comparative study, 35 control women (group A) did not receive any pharmacological treatment,26 women (group B) received 25 µg of vaginal estradiol daily for 14 days and 400 µg of vaginal misoprostol 12 hours before hysteroscopic surgery, 32 women (group C) received 400 µg of vaginal misoprostol 12 hours before surgery.
Demographic data were well balanced and all variables were not significantly different among the three groups. The study showed a significant difference in the preoperative cervical dilatation among the group B (7.09±1.87 mm), the group A (5.82±1.85 mm; B vs. A, P=0.040) and the group C (5.46±2.07 mm; B vs. C, P=0.007). The dilatation was very easy in 73% of women in group B. The pain scoring post surgery was lower in the group B (B vs. A, P=0.001; B vs. C, P=0.077). In a small subgroup of women with suspected cervical stenosis, there were no statistically significant differences among the three groups considered. No complications during and post hysteroscopy were observed.
In postmenopausal women the pretreatment with oestrogen appears to have a crucial role in allowing the effect of misoprostol on cervical ripening. The combination of vaginal estradiol and vaginal misoprostol presents minor side effects and has proved to be effective in obtaining satisfying cervical dilatation thus significantly reducing discomfort for the patient.
评估绝经后妇女在宫腔镜手术前经阴道给予雌二醇预处理后再使用米索前列醇的有效性和安全性。
在这项观察性比较研究中，35名对照女性（A组）未接受任何药物治疗，26名女性（B组）每天接受25μg阴道雌二醇治疗，持续14天，并在宫腔镜手术前12小时接受400μg阴道米索前列醇治疗，32名女性（C组）在手术前12小时接受400μg阴道米索前列醇治疗。
人口统计学数据均衡，三组之间所有变量均无显著差异。研究显示，B组（7.09±1.87mm）、A组（5.82±1.85mm；B组与A组比较，P=0.040）和C组（5.46±2.07mm；B组与C组比较，P=0.007）术前宫颈扩张存在显著差异。B组73%的女性宫颈扩张非常容易。B组术后疼痛评分较低（B组与A组比较，P=0.001；B组与C组比较，P=0.077）。在一小部分疑似宫颈狭窄的女性亚组中，三组之间没有统计学上的显著差异。宫腔镜检查期间及术后未观察到并发症。
在绝经后妇女中，雌激素预处理似乎在使米索前列醇发挥宫颈成熟作用方面起着关键作用。阴道雌二醇和阴道米索前列醇联合使用副作用较小，已证明在获得满意的宫颈扩张方面有效，从而显著减轻患者的不适。
