宫腔粘连分离术后预防再粘连的临床研究  

Clinical study of preventing adhesion recurrence after transcervical resection of adhesion

作　　者：张玉婷[1] 陈江 石兵[3] 曹杰[1] 赵纯全[4] 

机构地区：[1]重庆医科大学附属大学城医院妇产科,重庆401331 [2]贵阳贵航医院肝胆肠外科,贵州贵阳550009 [3]重庆医科大学附属大学城医院消化中心,重庆401331 [4]重庆医科大学附属第一医院妇产科,重庆400016

出　　处：《中国妇幼健康研究》2015年第6期1269-1272,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨宫内节育器、球囊支架、宫内节育环加防粘连膜(interceed)3种材料对宫腔粘连分离术后患者宫腔再粘连的预防作用。方法从2011年1月至2014年2月于重庆医科大学附属大学城医院妇产科行宫腔粘连分离术的患者中选择409例作为研究对象。根据术前宫腔的粘连范围大小,将患者分为轻度、中度和重度,再根据术中宫内放置材料的不同,将患者分为3组。其中宫内放置节育环的患者为IUD组,共142例,放置球囊支架的患者为球囊组,共128例,放置interceed的患者为interceed组,共139例。术后进行随访,了解患者月经的改善情况,为期18个月,并于手术3个月后对所有患者行宫腔镜复查,观察宫腔的恢复情况及其形态。结果轻中度宫腔粘连患者宫腔粘连分离术后3组总有效率无显著性差异(x^2=0.090,P=0.956)。重度宫腔粘连患者中interceed组和球囊组的总有效率均显著高于IUD组(x^2值分别为4.770、4.636,均P<0.05),但interceed组和球囊组组间总有效率的差异不具有统计学意义(x^2=0.005,P>0.05)。在为期18个月的随访中,interceed组和球囊组患者月经的好转率分别为76.26%、78.91%,均显著高于IUD组的63.38%(x^2值分别为5.522、7.840,均P<0.05),但interceed组的好转率与球囊组的差异无统计学意义(x^2=0.268,P>0.05)。结论 3种材料对轻中度宫腔黏连患者术后再粘连的预防作用无显著差别,而对重度宫腔粘连患者术后,球囊支架、interceed防粘连膜均能显著降低其再粘连的发生,预防作用均优于节育环,但尚不能证明球囊支架与interceed防粘连膜的预防作用存在显著差异。Objective To study the clinical effects of intrauterine device （ IUD ）, Foley catheter and IUD with interceed absorbable adhesion barrier on preventing adhesion recurrence after transcervical resection of adhesion （TCRA）. Methods From January 2011 to February 2014 409 patients with intrauterine adhesion undergoing TCRA in University Hospital Affiliated to Chongqing Medical University were classified into mild patients, moderate patients and severe patients based on the range of intrauterine adhesion, and divided into three groups according to the material placed in intrauterine： IUD group （142 cases） placed with IUD, Foley catheter group （128 cases） placed with Foley catheter, and interceed group （139 cases） placed with intercede. The patients were followed up for 18 months to understand the improvement of menstruation, and were reviewed by hysteroscopy to observe the recovery condition of uterine 3 months after operation. Results For patients with mild and moderate IUA, the total effective rate was not significantly different among three groups （X2 = 0.090, P =0.956）. The total effective rate in interceed group and Foley catheter group was significantly higher than that in IUD group among the patients with severe IUA （X2 value was 4. 770 and 4.636, respectively, both P 〈 0.05 ）, but the difference between these two groups was not significant （X2 = 0.005, P 〉 0.05 ）. During the 18-month follow-up, the rate of menstruation improvement in interceed group and Foley catheter group was 76.26% and 78.91%, respectively, and both was significantly higher than that in IUD group （63.38%） （X2 value was 5. 522 and 7. 840, respectively, both P 〈 0.05 ）, but there was no significant difference between two groups （X2 = 0. 268, P 〉 0.05 ）. Conclusion There is no significant difference among three kinds of materials in patients with mild and moderate IUA, but interceed and Foley catheter can obviously reduce adhesion recurrence in patients with severe IUA, and both are superio

关 键 词：球囊支架 宫腔粘连 术后再粘连 interceed防粘连膜 节育器 

分 类 号：R713.4[医药卫生—妇产科学]