自交联透明质酸钠凝胶和Foley球囊对宫腔粘连分离术后再粘连的预防效果比较

目的比较自交联透明质酸钠凝胶和Foley球囊在宫腔粘连分离术(Transcervical resection of adhesions, TCRA)后患者中防治再粘连的效果。方法回顾性分析东莞市东南部中心医院妇科行TCRA的120例患者,按治疗方法不同分为球囊组(n=55)和明胶组(n=65)。球囊组于术后宫腔内放置Foley球囊,明胶组于术后宫腔内注射自交联透明质酸钠凝胶。对比两组防治TCRA术后再粘连的效果,术前和术后3个月采用美国生育协会评分(American fertility society, AFS)评价宫腔粘连范围、月经情况和粘连类型,并比较再粘连总发生率及并发症情况。结果明胶组预防TCRA术后宫腔再粘连总有效率优于球囊组,差异有统计学意义(P<0.05)。术后3个月,两组AFS评分均较术前降低,除粘连类型评分外,明胶组AFS各项评分均低于球囊组,差异均有统计学意义(P<0.05)。术后3个月,明胶组再粘连总发生率显著低于球囊组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论自交联透明质酸钠凝胶对TCRA术后再粘连的预防效果优于Foley球囊,且安全性良好。

Comparison of effects of self-crosslinked sodium hyaluronate gel and Foley balloon in prevention ofre-adhesion after intrauterine adhesion separation

Objective To compare effects of self-crosslinked sodium hyaluronate gel and Foley balloon in prevention ofreadhesion after transcervical resection of adhesion(TCRA). Methods A retrospective analysis was performed on 120 patients with TCRA in the department of gynecology of Dongguan Southeast central hospital. According to different treatment methods, they were divided into balloon group(n=55) and gelatin group(n=65). The balloon group was treated by placing a Foley balloon in the postoperativeintrauterine cavity, while the gelatin group received the injection of self-crosslinked sodium hyaluronate gel into the postoperativeintrauterine cavity. Then, the effects in the prevention of re-adhesion after TCRA, the extent and type of adhesion, the American Fertility Society(AFS) scores, the severity of uterine adhesions, and the complications were compared between the two groups before and 3 months after TCRA. Results The effects in the prevention of re-adhesion after TCRA of the gelatin group were better than those of the balloon group, and the difference was statistically significant(P<0.05). 3 months after TCRA, the AFS scores of the two groups were lower than those before TCRA. Except for the adhesion type score, the AFS scores of the gelatin group were lower than those of the balloon group, and the differences were statistically significant(P<0.05). 3 months after TCRA, the total incidence of adhesion in the gelatin group was significantly lower than that in the balloon group, and the difference was statistically significant(P<0.05). There was no difference in complications between the two groups. Conclusions Self-crosslinked sodium hyaluronate gel has better preventive effects on adhesion after TCRA than Foley balloon. Moreover, it can effectively reduce the incidence of moderate and severe postoperative adhesions.