羊膜制品在重度宫腔粘连治疗中的应用及疗效分析  

Clinical evaluation of amniontic products after transcervical resection of intensive degree of intrauterine adhesions

作　　者：王欣[1] 段华[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,100006

出　　处：《中华妇产科杂志》2016年第1期27-30,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市医院管理局临床医学发展专项（zylx201406）;首都卫生发展科研专项重点攻关项目（2014-1-2l12）;国家科技支撑计划（2014BA105803）

摘　　要：目的分析羊膜制品对宫腔粘连的治疗效果，评价羊膜制品应用于宫腔粘连分离手术后对子宫内膜的修复作用。方法选择2013年6月一2014年6月在首都医科大学附属北京妇产医院接受宫腔镜宫腔粘连分离术治疗的重度宫腔粘连患者（宫腔粘连评分1〉10分）57例，随机分为羊膜组29例和球囊组28例；羊膜组：术后将羊膜制品包裹于Foley球囊表面置入宫腔；球囊组：术后仅放置Foley球囊；两组患者均留置球囊7d后取出。行人工周期3个周期后实施宫腔镜二探术，观察宫腔粘连评分、月经改善情况以及妊娠结局，平均随访时间为（14．6±2．7）个月。结果（1）羊膜组患者的宫腔粘连评分由术前的（10．1＋0．5）分下降至术后的（3．2±1．5）分，差异有统计学意义（P〈0．01）；球囊组由术前的（10．1±0．5）分下降至术后的（6．3±2．5）分，差异有统计学意义（P〈0．01）。（2）羊膜组患者的月经量评分由术前的（13．3±4．4）分增加至术后的（32．6±5．5）分，差异有统计学意义（P〈0．01）；球囊组由术前的（11．1±5．8）分增加至术后的（26．5±5．6）分，差异有统计学意义（P〈0．01）；羊膜组患者术后月经改善情况优于球囊组（评分高于球囊组），两组比较，差异有统计学意义（P=0．002）。（3）羊膜组患者术后宫腔镜二探术时宫腔粘连评分≥5分的发生率为21％（6／29），球囊组为36％（10／28），两组比较，差异无统计学意义（P=0．248）。（4）在术后随访期内，羊膜组患者的妊娠率为28％（8／29），球囊组为21％（6／28），两组比较，差异无统计学意义（P=0．760）。结论小样本量观察显示，羊膜制品应用于重度宫腔粘连手术后的创面，能适当改善月经量，降低术后再粘连评分，但对妊娠率的改善有待进一步研究证实。Objective To evaluate the effect of amniotic products after transcervical resection of uterine adhesions （TCRA）. Methods This study was carried out in 57 patients with intensive degree of intrauterine adhesions （IUA） who had been treated by TCRA between Jun. 2013 to Jun. 2014. These patients were devided into two groups randomly. In group amnion, 29 patients were placed amniontic scaffold balloon after TCRA; in group balloon, 28 patients were placed Foley＇s balloon after TCRA. The two groups＇ balloons were taken out after TCRA 7 days. All patients were taken artificial cycle treatment. The uterine cavity form and the menstruation of 2 groups were observed in 3 months after TCRA. Results In group amnion, IUA score dropped from 10.1±0.5 preoperatively to 3.2± 1.5 postoperative （P〈0.01）, in group balloon, IUA score dropped from 10.1±0.5 preoperatively to 6.3±2.5 postoperative （P〈0.01）. In group amnion, the menstrual score increased from 13.3±4.4 preoperatively to 32.6± 5.5 postoperative （P〈0.01）, in group balloon, the menstrual score increased from 11.1 ±5.8 to 26.5±5.6 （P〈0.01）. The menstrual improvement of group amnion was better than that of group balloon significantly （P=0.002）. In group amnion, the recurrence rate of adhesion was 21% （6/29）, in group balloon, the recurrence rate of adhesion was 36% （10/28）. There was no significant difference （P=0.248）. The pregnancy rate of group amnion was 28% （8/29）, the pregnancy rate of group balloon was 21% （6/28）. The difference of pregnancy rate in two groups was not significant （P=0.760）. Conclusion This small sample observation indicate that amniotic products used in the treatment of intensive IUA could improve menstrual, reduce the recurrence of adhesion, but the impovement of the pregnancy rate should be confirmed by large sample observation.

关 键 词：子宫 黏连 羊膜 生物敷料 宫腔镜检查 治疗结果 

分 类 号：R713.4[医药卫生—妇产科学]