COOK球囊放置时长对重度宫腔粘连疗效的影响  

Efficacy of severe intrauterine adhesions

作　　者：曾薇薇[1] 苏圣梅 阎恺 古衍[1] 袁桢[1] 姚吉龙[1] ZENG Wei⁃wei;SU Sheng⁃mei;YAN Kai;GU Yan;YUAN Zhen;YAO Ji⁃long(Department of Gynecology,Shenzhen Maternity&Child Healthcare Hospital Affiliated to Southern Medical Universi⁃ty,Shenzhen 518028,Guangdong,China)

机构地区：[1]南方医科大学附属深圳市妇幼保健院妇科,深圳518028

出　　处：《医学研究生学报》2020年第6期618-622,共5页Journal of Medical Postgraduates

基　　金：深圳市医疗卫生类科研项目(201303081);深圳市妇幼保健院科研项目(FYB2017013)。

摘　　要：目的由于存在感染风险,目前在重度宫腔粘连(IUA)治疗中COOK球囊放置时间存在较大争议。文中探讨了COOK球囊放置时长对IUA患者疗效的影响。方法纳入2018年1月至2018年8月期间深圳市妇幼保健院收治的150例重度IUA患者,并按放置COOK球囊时长将入组患者随机均分为短期组(1周)、中期组(1个月)、长期组(2个月),比较各组患者行宫腔粘连分离手术(TCRA)后的再粘连情况及妊娠指标,同时分析相关的感染指标、宫腔恢复情况、美国生育协会(AFS)评分改善率、月经改善情况、子宫内膜厚度差异。结果中期组和长期组的妊娠率高于短期组,首次妊娠时间短于短期组(P<0.05)。长期组二探时取出COOK球囊微生物培养阳性率(48.00%)高于短期组(24.00%)和中期组(30.00%)(P<0.05)。中期组和长期组的宫腔恢复正常率(82.00%、78.00%)较短期组(56.00%)均显著增高(P<0.05)。二探术后中期组和长期组的AFS评分[(2.86±2.32)、(2.90±2.16)]较短期组(4.66±3.60)明显改善(P<0.05);但中期组和长期组间差异无统计学意义(P>0.05)。中期组和长期组术后6个月及12个月月经改善率和子宫内膜增厚较短期组更为显著(P<0.05),但中期组和长期组间差异无统计学意义(P>0.05)。结论COOK球囊放置1个月以上能更有效改善宫腔形态和AFS评分,提高妊娠率和缩短术后首次妊娠时间,但放置2个月者潜在感染风险增高。Objective To investigate the effect of COOK balloon placement time on the efficacy of severe intrauterine adhe⁃sions.Methods 150 patients with severe IUA were prospectively enrolled and randomized divided into three short⁃term group,medi⁃um⁃term group and long⁃term group,with respectively balloon placement time 1 week,1 month and 2 months.All subjects underwent transcervical resection of adhesion(TCRA).Re⁃adhesion and pregnancy rate after treatment,the relevant infection indicators,uterine cavity recovery,AFS score improvement rate,menstrual improvement,and endometrial thickness were analyzed.Results All pa⁃tients underwent transcervical resection of adhesion(TCRA)and COOK balloon placement successfully.Improvement of pregnancy rate and first pregnancy time were observed in group B and C than group A(P<0.05).The total effective rate of 12 months after treatment of group B(84.00%)and group C(86.00%)was better than group A(64.00%)(P<0.05).The positive rate of microbial culture of COOK balloon when took out at the second⁃look showed highest in group C(48.00%,P<0.05),followed by group B(30.00%)and group A(24.00%).The rate of uterine recovery of group B(82.00%)and C(78.00%)was better than group A(56.00%)(P<0.05).There were more patients with AFS score improvement in group B and C than group A(P<0.05).Similar improvement of menstrual and increasing of endometrium thickness were observed at the 6th and 12th months in group B and C after operation(P>0.05).Conclusion Placement of the uterine COOK balloon for more than 1 month may improve uterine cavity,pregnancy rate,AFS score,menstruation and endometrial thickness.However,the risk of infection increased at the second month after COOK balloon placement.

关 键 词：宫腔粘连 宫腔粘连分离术 COOK球囊 放置时间 妊娠率 

分 类 号：R713.8[医药卫生—妇产科学]