宫腔镜下宫腔粘连分离术后实施球囊扩张术预防再粘连的临床疗效研究  

Clinical study on prevention of readhesion by balloon dilatation after transcervical resection of adhesion

作　　者：蒋亚萍 赵莉[1] 宋安娜 孔俏俏 刘涛[1] JIANG Ya-ping;ZHAO Li;SONG An-na;KONG Qiao-qiao;LIU Tao(Department of Reproductive Genetics,The Affiliated Taian City Central Hospital of Qingdao University,Taian,Shandong 271000,China)

机构地区：[1]青岛大学附属泰安市中心医院生殖遗传科,山东泰安271000

出　　处：《中国妇幼保健》2025年第3期472-476,共5页Maternal and Child Health Care of China

基　　金：山东省医药卫生科技发展计划项目(2019WS209);山东省自然科学基金青年项目(ZR2020QC102)。

摘　　要：目的探讨宫腔镜下宫腔粘连分离术(TCRA)后再次实施球囊扩张术对于预防再粘连的临床疗效,为降低术后粘连复发提供参考依据。方法选取2020年1月—2022年10月青岛大学附属泰安市中心医院诊治的中、重度宫腔粘连(IUA)患者104例。按照术后应用球囊情况分为研究组(二次球囊扩张)62例和对照组(单次球囊扩张)42例,术后随访患者月经改善情况及妊娠情况,结合宫腔镜检查结果,比较两种方法的疗效。结果根据欧洲妇科内镜学会(ESGE)分级标准,研究组术后宫腔恢复正常40例(64.52%)、轻度IUA16例(25.81%)、中度IUA 6例(9.67%)及重度IUA 0例(0.00%);对照组术后宫腔恢复正常17例(40.48%)、轻度IUA15例(35.71%)、中度IUA10例(23.81%)及重度IUA 0例(0.00%),两组比较,差异有统计学意义(Z=-2.569,P<0.05)。研究组月经恢复总有效率88.71%高于对照组71.42%,两组比较,差异有统计学意义(χ^(2)=5.088,P<0.05)。宫腔镜下宫腔粘连分离术术后12个月的随访中,研究组妊娠29例(46.78%)、流产10例(16.13%);对照组妊娠13例(30.95%)、流产6例(14.29%),两组妊娠率、流产率比较,差异均无统计学意义(均P>0.05)。结论对于中、重度IUA患者,TCRA术后再次实施球囊扩张术能降低粘连程度,改善粘连复发率和月经情况,对预防术后再粘连有一定的临床价值。Objective The aim of this study was to investigate the efficacy of balloon dilatation for preventing readhension after transcervical resection of adhesion(TCRA),provide a reference basis for reducing recurrence of postoperative adhesion.Methods A clinical trial to be conducted at the Affiliated Taian City Central Hospital of Qingdao University between January 2020 and October 2022.One hundred and four women with moderate and severe intrauterine adhesion(IUA)underwent TCRA were enrolled:62 patients were in the study group(second balloon dilation group)and 42 patients were in the control group(single balloon dilation group).Curative effect will be assessed by follow-up of menstrual improvement as well as subsequent fertility and by performing review using hysteroscopy after surgery.Results According to the ESGE grading criteria,the postoperative recovery of the uterine cavity in the study group was 40(64.52%),mild was 16(25.81%)cases,moderate was 6(9.67%),and severe was 0.In the control group,the postoperative recovery of the uterine cavity was 17(40.48%),mild was 15(35.71%),moderate was 10(23.81%),and severe was 0 cases,with a statistically significant difference(Z=-2.569,P<0.05).The effective rate of menstrual recovery in the study group was 55/62(88.71%),which was higher than that in the control group of 30/42(71.42%),and the difference was statistically significant(χ^(2)=5.008,P<0.05).In the 12 month follow-up after TCRA surgery,there were 29 pregnancies(46.78%)and 10 miscarriages(16.13%)in the study group,13 pregnancies(30.95%)and 6 miscarriages(14.29%)in the control group.There was no statistically significant difference in pregnancy and miscarriage rates between the two groups(P>0.05).Conclusion This small sample study indicate that balloon dilatation used in the treatment of moderate and severe IUA following TCRA could improve menstrual,reduce the recurrence of adhesion and severity of adhesions,which has certain clinical value on preventing postoperative adhesions.

关 键 词：宫腔粘连 宫腔镜 球囊扩张术 雌激素 

分 类 号：R713[医药卫生—妇产科学]