防宫腔粘连隔离器在宫腔粘连治疗中的应用及疗效分析  

Clinical evaluation of intrauterine isolatoron preventing re-adhesion after transcervical resection of intrauterine adhesions

作　　者：韩男男 李甦 杨颖倩 王媁[1] 周德兰[1] 戴辉华[1] 韩素萍[1] Han Nannan;Li Su;Yang Yingqian(Department of Obstetrics and Gynecology,the First Affliated Hospital of Nanjing Medical University,Nanjing 210036)

机构地区：[1]南京医科大学第一附属医院妇产科

出　　处：《现代妇产科进展》2020年第2期111-115,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨防宫腔粘连隔离器(简称隔离器)用于宫腔粘连分离术后预防再粘连的有效性及安全性,评价隔离器在宫腔粘连分离术后维持宫腔正常形态的优势。方法:选取2015年8月至2017年2月在南京医科大学第一附属医院接受治疗的中重度宫腔粘连(宫腔粘连评分≥5分)患者60例。将患者随机分为隔离器组30例(宫腔粘连分离术后宫腔放置隔离器)和宫内节育器组30例(术后宫腔放置Tcu380宫内节育器),两组患者术后均行雌孕激素序贯治疗,4周后行二次宫腔镜探查术。比较两组患者的宫腔粘连评分下降情况、月经改善情况、妊娠结局及放置后副反应,所有患者术后随访2年。结果:隔离器组患者的宫腔粘连评分术前(9.5±2.0)分,二次宫腔探查时(0.7±1.0)分,差异有统计学意义(P<0.01);节育器组术前(8.7±1.9)分,二次宫腔探查时(3.7±2.7)分,差异有统计学意义(P<0.01);隔离器组二次宫腔探查时宫腔粘连评分明显小于节育器组评分,差异有统计学意义(P<0.01)。隔离器组和节育器组二次宫腔探查时宫腔粘连评分≥5分发生率分别为0(0/30)和43%(13/30),两组比较差异有统计学意义(P<0.01);月经改善率分别为60%(18/30)和47%(14/30),两组比较差异无统计学意义(P=0.301)。随访2年,隔离器组和节育器组的妊娠率比较,差异均无统计学意义(47%vs 43%,P=0.795)。隔离组和节育器组的术后阴道出血时间比较,差异均无统计学意义[(6±3)天vs (5±2)天,P=0.078]。两组患者术后均未出现发热、泌尿生殖道感染、过敏反应、腹痛、子宫穿孔、隔离器或节育器下移或脱落、带器妊娠等副反应。结论:隔离器用于中重度宫腔粘连分离术后预防宫腔再粘连无明显副反应,在维持术后宫腔正常形态及减少术后再粘连方面有独特优势,在术后月经恢复方面及妊娠结局的改善方面与节育器组无显著差异。Objective:To evaluate the effect and safety of intrauterine isolator after transcervical resection of uterine adhesions(TCRA),and to analyze the advantage of intrauterine isolator over intrauterine-devices in preventing re-adhesion.Methods:This study was carried out in 60 patients,who had moderate to severe degrees of intrauterine adhesion(IUA) and had been treated by TCRA between Aug.2015 to Feb.2017 in Jiangsu Province Hospital.Patients were randomly divided into two groups.In group intrauterine isolator,30 patients were placed with intrauterine isolators after TCRA;in group intrauterine devices,30 patients were placed with intrauterine-devices after TCRA.All patients were taken artificial cycle treatment.The IUA score and uterine cavity form of two groups were observed in one months after TCRA,and the menstruation and pregnancy were observed in the following two years.Results:In group intrauterine isolator,IUA score dropped from 9.5±2.0 preoperatively to 0.7±1.0 postoperatively(P<0.01);in group intrauterine devices,IUA score dropped from 8.7±1.9 preoperatively to 3.7±2.7 postoperatively(P<0.01).There was no difference in IUA score of first-operation in two groups(P=0.706).However,there was a significant difference in IUA score of second-operation in two groups(P<0.01).In group intrauterine isolator,the recurrence rate of adhesion was 0%,while in group intrauterine devices,the recurrence rate of adhesion was 43%(13/30).The difference in two groups was not serious(P<0.01).The menstrual improvement rate of group intrauterine isolator was 60%(18/30),the menstrual improvement rate of group intrauterine devices was 47%(14/30).The difference of menstrual improvement rate in two groups was not significant(P=0.301).The pregnancy rate of intrauterine isolator was 47%(14/30),the pregnancy rate of group intrauterine devices was 43%(13/30).The difference of pregnancy rate in two groups was not significant(P=0.795).In group intrauterine isolator,the average vaginal bleeding time of patients is 6±3 days,in group intraut

关 键 词：宫腔粘连 防宫腔粘连隔离器 宫内节育器 人工周期 月经改善 妊娠结局 

分 类 号：R713[医药卫生—妇产科学]