中重度宫腔粘连术后两种预防宫腔再粘连方法的临床效果比较  

Comparison of two clinical methods for prevention of intrauterine re-adhesion after moderate and severe intrauterine adhesions

作　　者：沈丹婷[1] 夏伟兰[2] 吴丽雅[1] 孙静[1] 

机构地区：[1]暨南大学附属深圳市宝安区妇幼保健院妇科,广东深圳518100 [2]南方医科大学附属深圳市龙华区人民医院妇二科,广东深圳518100

出　　处：《中国计划生育和妇产科》2017年第6期44-47,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的比较中重度宫腔粘连分离术(transcervical resection of adhesion,TCRA)后两种预防宫腔再粘连方法的临床效果。方法回顾性分析2014年9月至2016年11月在深圳市宝安区妇幼保健院确诊为中重度宫腔粘连(intrauterine adhesions,IUA)的120例患者的病例资料,随机分为A组57例、B组63例。两组患者术后均使用人工周期+阿司匹林肠溶片,A组术后宫腔放置宫内节育器+透明质酸钠,B组术后宫腔放置Foley球囊导尿管+透明质酸钠,比较两组患者术后宫腔形态、月经改善及妊娠情况。结果中度IUA患者中,A组、B组的宫腔形态好转率分别为38.7%、51.5%,治愈率分别为19.4%、36.4%,再粘连率分别为67.7%、45.5%,月经改善有效率分别为54.8%、81.8%,妊娠率分别为36.4%、54.5%;重度IUA患者中,A组、B组的宫腔形态好转率分别为34.6%、46.4%,治愈率分别为11.5%、28.6%,再粘连率分别为84.6%、60.7%,月经改善有效率分别为38.5%、71.4%,妊娠率分别为11.1%、22.2%。以上各项疗效比较差异均有统计学意义(P<0.05)。结论中重度IUA分离术后使用Foley球囊导尿管+透明质酸钠组治疗效果优于宫内节育器+透明质酸钠,值得临床推广。Objective To compare the clinical effect of two kinds of uterine re - adhesions after transcervical resection of adhesion （TCRA） for moderate and severe intrauterine adhesions. Methods Retrospective analyzed the data of 120 cases of patient diagnosed with moderate intrauterine adhesions （IUA） from September 2014 to November 2016 in Shenzhen Bao＇an District Maternal and Child Health Hospital. They were randomly divided into group A of 57 cases and group B of 63 cases. The two groups were treated with artificial cycle ＋ aspirin enteric - coated tablets. Group A was placed intrauterine device ＋ sodium hyaluronate post operation and group B was placed Foley balloon catheter ＋ sodium hyaluronate post operation. Compared the two groups of patients in postoperative uterine cavity morphology, menstrual improvement and pregnancy. Results Of patients with moderate IUA,the rates of improvement of uterine cavity in group A and group B were 38. 7 % and 51.5 % respectively. The cure rates were 19.4 % and 36.4 % respectively. The rates of re - adhesions were 67. 7 % and 45.5 % respectively. Menstrual improvement rates were 54. 8 % and 81.8 % while pregnancy rates were 36.4 % and 54. 5 % ; Of patients with severe IUA, the rates of improvement of uterine cavity in group A and group B were 34. 6% and 46.4% respectively. The cure rates were 11.5 % and 28. 6 % respectively. The rates of re - adhesions were 84. 6 % and 60. 7 % respectively. Menstrual improvement rates were 38.5 % and 71.4 % while pregnancy rates were 11.1% and 22. 2 %. Conclusion The use of Foley balloon catheter ＋ sodium hyaluronate in the treatment of moderate to severe IUA was superior to intrauterine device ＋ sodium hyaluronate, which was worthy of clinical promotion.

关 键 词：宫腔粘连分离术 再粘连 宫内节育器 球囊导尿管 宫腔镜探查 

分 类 号：R711.74[医药卫生—妇产科学]