中重度宫腔粘连分离术后三种方式预防复发的对比  

Comparison of three ways to prevent recurrence after separation of moderate and severe intrauterine adhesions

作　　者：马凯驰 刘明星[1] 欧妙娴 刘文利[1] 邓清文 李竞雄[1] 许培 Ma Kaichi;Liu Mingxing;Ou Miaoxian;Liu Wenli;Deng Qingwen;Li Jingxiong;Xu Pei(Department of Obstetrics and Gynecology,Guangzhou Institute of Obstetrics and Gynecology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Department of Obstetrics and Gynecology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]广州医科大学附属第三医院妇产科/广州市妇产科研究所/广州重症孕产妇救治中心,广东广州510150 [2]中山大学附属第一医院妇产科,广东广州510080

出　　处：《实用妇科内分泌电子杂志》2023年第3期6-11,共6页Electronic Journal of Practical Gynecological Endocrinology

基　　金：广州市科技计划项目(编号202102010138)(编号202201011465)。

摘　　要：目的针对中重度宫腔粘连分离术后患者,比较宫腔扩张术与放置宫内节育器(IUD)、IUD联合防粘连剂这三种方式预防粘连复发的临床疗效。方法回顾性分析196例因中度及重度宫腔粘连行宫腔镜下粘连分离术(TCRA)患者,其中A组为宫腔扩张组(50例),B组为IUD组(42例),C组为IUD联合防粘连剂组(104例)。使用AFS评分评价宫腔粘连程度。所有患者均行第二次宫腔镜检查,比较三组患者AFS改善值、宫腔粘连复发率及随访1年内的妊娠率。结果TCRA术后三组患者AFS改善值分别为(5.58±2.17)分、(5.29±2.62)分、(5.95±2.22)分,比较差异无统计学意义(F=1.374,P>0.05)。三组患者术后宫腔粘连复发率分别为42.0%、42.9%、30.8%,差异无统计学意义(χ^(2)=2.861,P>0.05)。三组患者术后1年内妊娠率分别为48.1%、40.5%、31.7%,三组妊娠结局比较差异无统计学意义(χ^(2)=2.890,P>0.05)。结论中重度宫腔粘连分离术后,宫腔扩张术可替代传统的IUD及IUD联合防粘剂治疗方法,是预防宫腔粘连复发的一种新方法。Objective To compare the efficacy of three therapies which is expanding uterus,intrauterine device(IUD)and anti-adhesion agent combined with IUD in the prevention of adhesion reformation after transcervical resection of adhesions(TCRA)for moderate to severe intrauterine adhesions(IUA).Methods Retrospective analysis was performed on 196 patients who underwent hysteroscopic adhesion separation(TCRA)due to moderate or severe intrauterine adhesion,including group A(50 cases),group B(42 cases),and group C(104 cases)with IUD combined with anti-adhesion agent.AFS score was used to evaluate intrauterine adhesions.All patients underwent a second hysteroscopy,and the improvement value of AFS,the recurrence rate of intrauterine adhesions and the pregnancy rate within 1 year of follow-up were compared among the three groups.Results The improvement values of AFS after TCRA were(5.58±2.17)points,(5.29±2.62)points and(5.95±2.22)points,respectively,with no statistical significance(F=1.374,P>0.05).The recurrence rates of intrauterine adhesion were 42.0%,42.9%and 30.8%,respectively,and there was no significant difference among the three groups(χ^(2)=2.861,P>0.05).The pregnancy rate of the three groups was 48.1%,40.5%and 31.7%,respectively,and there was no significant difference in pregnancy outcome among the three groups(χ^(2)=2.890,P>0.05).Conclusion Expanding uterus can replace the traditional treatment of IUD and anti-adhesion agent combined with IUD,which is a new method to prevent the recurrence of intrauterine adhesions after TCRA.

关 键 词：宫腔粘连 宫腔扩张术 防粘剂 宫内节育器 妊娠率 宫腔镜 

分 类 号：R713.4[医药卫生—妇产科学]