COOK球囊联合雌孕激素序贯治疗预防宫腔镜下宫腔粘连分离术后宫腔再粘连的临床效果观察

目的:探讨宫腔镜下宫腔粘连(IUA)分离术后COOK球囊联合雌孕激素对预防宫腔再次粘连的临床效果,并探讨COOK球囊留置的时间。方法:选择我院2016年4月至2017年10月中重度IUA患者227例,随机分为4组:其中A组55例放置COOK球囊作为观察组A组,7天后取出;B组68例放置COOK球囊作为观察组B组,3月后取出;C组64例放置“宫型”宫内节育器(IUD)为观察组C组,3个月后取出;D组40例仅行宫腔镜下IUA分离术,作为空白对照组D组。4组术后第2天开始均应用戊酸雌二醇片(2mg,每天3次,口服)联合地屈孕酮片(10mg,每天1次,口服)序贯治疗,连续用药3个周期。分别比较4组治疗前后子宫腔状态、月经情况、妊娠率、患者满意度及有无并发症等。结果:治疗3个月后,B组IUA改善率、月经改善率、妊娠率及患者满意度均高于A组、C组、D组,差异有统计学意义(P<0.05);B组植入物脱落率和嵌顿率明显低于C组(P<0.05);B组与C组细菌感染率差异无统计学意义(P>0.05)。结论:宫腔内放置COOK球囊3个月联合雌孕激素序贯治疗预防宫腔镜下IUA分离术后宫腔再粘连的方法在临床上的安全性及有效性均值得肯定。

Clinical Effects of COOK Balloon Combined with Estradiol and Progesterone in Preventing Uterine Re-adhesion after Hysteroscopic Adhesion Separation

Objective:To explore the clinical effects of COOK balloon combined with estradiol and progesterone on preventing intrauterine re-adhesion after hysteroscopic adhesion separationand the time of COOK balloon retention.Methods:From April 2016 to October 2017,227 patients who received hysteroscopic adhesion separationin our hospital because of severe intrauterine adhesion(IUA) were selected and divided into four groups.55 cases in group A(observation A group) were treated with COOK balloon,which was removed after seven days.68 cases in group B(observation B group) were treated with COOK balloon,which was removed after 3 months.The group C(observation C group) including 64 patients were treated with intrauterine device(IUD),which was removed after 3 months.40 patients in group D(blank control D group) were treated by hysteroscopic adhesion separation only.All of the four groups were treated with progynova tablets(2mg tid po) combined with ditropigestrel tablets(10mg qd po) in sequence at the second day after surgery,with continuous drug use for 3 cycles.After treatment, the uterine cavity status,menstrual condition,pregnancy rate,patient satisfaction and complications were compared among the four groups.Results:After 3 months,there were a statistically significantincreasein the degree of intrauterine adhesion, menstrual recovery,pregnancy rate and patient satisfaction in group B compared to those in group A,C and D(P< 0.05).The implant shedding rate and incarceration rate in group B were significantly lower than those in group C(P< 0.05). There was no significant difference in the infection rate between group B and group C(P>0.05).Conclusions:Prevention of intrauterine re-adhesion after hysteroscopic adhesion separation by placement of COOK balloon combined with estrogen and progesterone for 3 monthshas been proved to be safe and effective.