宫腔镜下宫腔粘连分离术的不同辅助治疗方案对中重度宫腔粘连患者的临床疗效比较  

Clinical efficacy of different adjuvant treatment schemes for patients with moderate to severe intrauterine adhesions after hysteroscopic transcervical resection

作　　者：石雯 王茂彩 王敏仪[1] 陈姗[1] 李骁[1] Shi Wen;Wang Maocai;Wang Minyi;Chen Shan;Li Xiao(Department of Gynecology,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院妇科,广州510655

出　　处：《新医学》2022年第11期833-837,共5页Journal of New Medicine

摘　　要：目的比较宫腔镜下宫腔粘连分离术(TCRA)的不同辅助治疗方案对中重度宫腔粘连患者的临床疗效。方法收集98例中重度宫腔粘连住院患者的临床资料。所有患者均行宫腔镜下TCRA,按患者的辅助治疗方案分为3组:TCRA组(A组,17例)、TCRA+子宫球囊支架置入术组(B组,35例)和TCRA+子宫球囊支架置入术+透明质酸钠宫腔注射组(C组,46例)。所有患者术后均行人工周期治疗,并在术后1个月行宫腔镜检查评估宫腔粘连情况。记录所有患者手术前后的美国生殖协会标准(AFS)评分,并观察术后3个月3组患者的月经量变化。结果3组中重度宫腔粘连患者在TCRA术前的AFS评分比较差异无统计学意义(P>0.05),在术后1个月复查宫腔情况的AFS评分比较差异有统计学意义(P<0.05),其中C组TCRA术后1个月AFS评分低于A组和B组(P均<0.05)。术后3个月,A组、B组和C组的月经量改善有效率分别为41%(7/17)、63%(22/35)和91%(42/46),组间比较差异均有统计学意义(P均<0.05);其中C组的月经量改善有效率高于A组和B组(P均<0.017)。结论TCRA联合术中宫内置入子宫腔球囊支架和透明质酸钠、术后进行人工周期治疗的综合治疗方案对中重度宫腔粘连患者的疗效良好,有利于患者的术后恢复。Objective To compare the clinical efficacy of different adjuvant treatment schemes for patients with moderate to severe intrauterine adhesions after hysteroscopic transcervical resection of adhesion(TCRA).Methods Clinical data of 98 patients with moderate to severe intrauterine adhesions were retrospectively analyzed.All patients underwent hysteroscopic TCRA for intrauterine adhesions.According to the adjuvant treatment schemes,all patients were divided into the TCRA group(group A,n=17),TCRA+balloon stenting group(group B,n=35)and TCRA+balloon stenting+intrauterine injection of sodium hyaluronate group(group C,n=46).Postoperatively,all patients received artificial cycle treatment.At postoperative 1 month,hysteroscopy was performed to evaluate the severity of intrauterine adhesions.The American Fertility Society(AFS)scores of all patients were recorded before and after surgery.The changes of menstrual volume at postoperative 3 months were observed in three groups.Results The differences of pre-TCRA AFS scores in 3 groups were not statistically significant(P>0.05).Hysteroscopy at postoperative 1 month found statistical significance in the AFS scores among three groups(P<0.05),and the AFS score in group C was significantly lower than those in groups A and B(both P<0.05).There was significant difference in the changes of menstrual volume among three groups at postoperative 3 months(all P<0.05).The effective rates of menstrual volume improvement were 41%(7/17),63%(22/35)and 91%(42/46)in groups A,B and C,and the differences were statistically significant(all P<0.05).The effective rate of menstrual volume improvement in group C was significantly higher compared with those in groups A and B(both P<0.017).Conclusion TCRA combined with intraoperative intrauterine placement of balloon stent,sodium hyaluronate and postoperative artificial cycle treatment yield high clinical efficacy for moderate to severe intrauterine adhesions and accelerate postoperative recovery.

关 键 词：宫腔粘连 宫腔粘连分离术 子宫球囊支架置入术 透明质酸钠 治疗 

分 类 号：R713.4[医药卫生—妇产科学]