自交联透明质酸钠凝胶预防中重度宫腔粘连分离术后再粘连

目的探讨宫腔镜下中重度宫腔粘连(intrauterine adhesion,IUA)粘连分离术后放置自交联透明质酸钠凝胶预防术后再粘连的价值。方法2016年9月~2018年1月90例美国生育学会(American Fertility Society,AFS)IUA评分为中重度IUA在宫腔镜下行冷刀粘连分离,按照术后预防粘连方法不同分为观察组和对照组,每组45例,观察组粘连分离后宫腔内放置自交联透明质酸钠凝胶防止术后再粘连,对照组粘连分离后宫腔内放置金属宫形环防止术后再粘连。术后2个月进行第2次宫腔镜检查,再次对IUA进行分级,评价术后2个月防止IUA的有效率。结果2组均未发生冷刀粘连分离术及材料相关的不良事件和并发症。术后2个月宫腔镜二次探查:观察组术后宫腔粘连有效率80.0%(36/45),明显高于对照组60.0%(27/45)(χ^2=4.286,P=0.038);观察组IUA累及范围得分和AFS总分明显低于对照组(t=-3.901,P=0.000;t=-3.360,P=0.001);观察组中重度IUA发生率为15.6%(7/45),明显低于对照组35.6%(16/45)(χ^2=4.731,P=0.030)。结论术后宫腔内放置自交联透明质酸钠凝胶能够有效减少中重度IUA分离手术后再粘连发生率,并降低粘连严重程度,预防IUA复发优于宫形环。

Self-crosslinked Sodium Hyaluronate Gel for the Prevention of Re-adhesion After Separation of Moderate to Severe Intrauterine Adhesion

Objective To investigate the value of placement of self-crosslinked sodium hyaluronate gel after separation of moderate to severe intrauterine adhesion(IUA)under hysteroscopy to prevent postoperative re-adhesion.Methods From September 2016 to January 2018,90 cases of moderate to severe IUA classified by IUA score of American Fertility Society(AFS)were divided into observation group(n=45)and control group(n=45)according to different mothods of preventing postoperative re-adhesion.The adhesion was separated by cold knife under hysteroscopy.In the observation group,self-crosslinked sodium hyaluronate gel was placed in the uterine cavity after adhesion separation to prevent postoperative re-adhesion,while in the control group,metal uterine ring was placed in the uterine cavity after adhesion separation to prevent postoperative re-adhesion.The second hysteroscopy was performed 2 months after operation.The uterine adhesion was graded again,and the effective rate of preventing uterine adhesion 2 months after operation was evaluated.Results No material-related adverse events and complications occurred during cold knife adhesion separation.The second hysterescopy 2 months after operation showed that the rate of uterine adhesion was 80.0%(36/45),which was significantly higher than that in the control group60.0%(27/45),χ^2=4.286,P=0.038].In the observation group,the range score and IUA score were significantly lower than those in the control group(t=-3.901,P=0.000;t=-3.360,P=0.001).The incidence of moderate to severe intrauterine adhesion was 15.6%(7/45)at 2 months after operation in the observation group,which was significantly lower than the control group35.6%(16/45),χ^2=4.731,P=0.030].Conclusion Postoperative self-crosslinked sodium hyaluronate gel can effectively reduce the incidence of re-adhesion after separation of moderate to severe IUA,reduce the severity of adhesions,and prevent the recurrence of adhesions better than uterine ring.