宫腔放置人羊膜预防中重度宫腔粘连术后复粘的临床效果及对预后的影响分析  

Clinical effect of placing human amniotic membrane in uterine cavity to prevent postoperative re adhesion of moderate and severe uterine adhesion and its impact on prognosis

作　　者：丰颖[1] FENG Ying(Department of Obstetrics and Gynecology,the SecondAffiliated Hospital of Nanchang University,Nanchang,Jiangxi,330006,China)

机构地区：[1]南昌大学第二附属医院妇产科,江西南昌330006

出　　处：《当代医学》2022年第5期34-37,共4页Contemporary Medicine

基　　金：江西省卫生厅科技计划(20165280)。

摘　　要：目的探讨并分析在中重度宫腔粘连患者的宫腔中放置人羊膜对术后复粘的预防效果以及对患者预后的影响。方法选取2015年7月至2017年3月在南昌大学第二附属医院因诊断宫腔中重度粘连并有再生育要求而行宫腔镜下子宫粘连松解术治疗的患者58例,根据病情严重程度分为中度粘连组和重度粘连组,各29例。所有患者均行腹腔镜监护下宫腔镜下子宫内粘连松解术,术后放置包裹人羊膜的Foley导尿管球囊7~14 d预防复粘,并给予戊酸雌二醇片联合地屈孕酮行人工周期治疗3月,比较两组患者术后再次宫腔粘连发生率、月经改善情况以及妊娠结局。结果治疗后,中度粘连组宫腔粘连复发率明显低于重度粘连组(P<0.05);中度粘连组患者月经总改善率明显高于重度粘连组(P<0.05);中度粘连组妊娠丢失、活产及胎盘粘连发生率明显低于重度粘连组(P<0.05)。结论中重度宫腔粘连患者术后在宫腔中放置人羊膜可以获得较好的治疗效果,月经情况明显改善,且具有较好的预防宫腔粘连复发的效果,值得临床推广应用。Objective To investigate and analyze the preventive effect of placing human amniotic membrane in the uterine cavity of patients with moderate and severe intrauterine adhesion on postoperative re adhesion and its impact on the prognosis of patients. Methods 58 patients in the Second Affiliated Hospital of Nanchang University who underwent hysteroscopic uterine adhesion lysis due to the diagnosis of moderate and severe uterine adhesion and the requirement of reproduction from July 2015 to March 2017 were selected. They were divided into moderate adhesion group and severe adhesion group according to the severity of the disease, with 29 cases in each group. All patients underwent hysteroscopic uterine adhesion lysis under laparoscopic monitoring. Foley catheter balloon wrapped with human amniotic membrane was placed for 7-14 days to prevent re adhesion, and estradiol valerate tablets combined with didroxyprogesterone was given artificial cycle treatment for 3 months. The incidence of re intrauterine adhesion, menstrual improvement and pregnancy outcome were compared between the two groups. Results After treatment, the recurrence rate of intrauterine adhesion in moderate adhesion group was significantly lower than that in severe adhesion group(P<0.05);the total improvement rate of menstruation in moderate adhesion group was significantly higher than that in severe adhesion group(P<0.05);the incidence of pregnancy loss, live birth and placental adhesion in moderate adhesion group was significantly lower than those in severe adhesion group(P<0.05).Conclusion The placement of human amniotic membrane in the uterine cavity after operation in patients with moderate and severe intrauterine adhesion can obtain better therapeutic effect, improve the menstrual condition of patients, and have better effect of preventing the recurrence of intrauterine adhesion, which is worthy of clinical application.

关 键 词：宫腔粘连 人羊膜 宫腔镜 复粘 

分 类 号：R713.4[医药卫生—妇产科学]