羊膜移植对预防宫腔粘连电切术后宫腔再粘连的研究

目的:探讨羊膜移植对预防宫腔粘连电切术后宫腔再粘连的效果。方法:2011年4月～2012年8月在新乡医学院第三附属医院妇产科行宫腔镜诊断的宫腔粘连患者70例,在B超监护下探测宫腔深度及方向,再用宫颈扩张棒逐号扩张至11.5号,所有患者在B超监护下,按科学合理的宫腔镜常规操作,采用环状或针状电极电切的方法。术中记录手术所用时间及灌流量。术后宫腔内放14Fr～10 ml双腔气囊导尿管,去除球囊顶端部,囊内充水3～9 ml。球囊外敷新鲜羊膜同时接引流袋持续开放引流。术后预防感染治疗5天,术后第二天采用雌、孕激素序贯疗法建立人工月经周期3个月,必要时进行第二次分离术。结果:70例宫腔粘连中包括轻度37例,中度22例,重度11例,术后观察1～6个月,宫腔形态恢复正常67例,有效率达到了95.7%,只有3例无效(均为重度患者)。结论:进行宫腔镜宫腔粘连分离术时配合羊膜移植对治疗宫腔粘连及预防宫腔再粘连效果好,操作简单,值得推广。

Study on prevention of intrauterine readhesion after intrauterine adhesion electrocision with amniotic membrane transplantation

Objective:To explore the effect of amniotic membrane transplantation for prevention of intrauterine readhesion after intrauterine adhesion electrocision.Methods:Seventy patients with intrauterine adhesion who underwent hysteroscopic diagnosis in the hospital from April 2011 to August 2012 were selected,the depth and direction of intrauterine cavity were detected under monitoring of type B ultrasound,then the cervix were dilated to 11.5 size with cervical dilation rods,conventional hysteroscopy was performed under monitoring of type B ultrasound,loop or needle electrode electroexcision was used in the study;the operation time and intraopoerative volume of perfusion were recorded;14Fr-10 ml double-chamber aerocyst urethral catheter was placed into cervical cavity,the top of sacculus was removed and 3-9 ml water was filled into the sacculus;fresh amniotic membrane was applied on sacculus externally,at the same time,drainage pack was open to drain;after operation,the patients were treated for 5 days to prevent infection,sequential therapy of estrogen and progesterone was used on the second day after operation to establish artificial menstrual cycle for 3 months,if necessary,the second exclusion of interuterine adhesion was performed.Results:Among seventy patients with intrauterine adhesion,37 patients with mild intrauterine adhesion,22 patients with moderate intrauterine adhesion,and 11 patients with severe intrauterine adhesion were included;all the patients were observed for 1-6 months after operation,the intrauterine cavity morphology of 67 patients returned to normal,the effective rate was 95.7%,the treatment was ineffective in only three patients(all of them were severe patients).Conclusion:The curative effect of exclusion of interuterine adhesion combined with amniotic membrane transplantation is good,and the preventive effect of the method for intrauterine readhesion is also good,the operation is simple and the method is worthy to be popularized.