宫腔粘连术后应用三腔导管负压冲洗引流装置的临床疗效观察

目的:探讨宫腔三腔导管负压冲洗引流装置在宫腔镜下宫腔粘连分离术(TCRA)后的应用效果。方法:选择收集2017年8月至2018年8月在郑州大学第三附属医院就诊并经宫腔镜检查确诊为中、重度宫腔粘连,近期有生育要求并愿意治疗和随访的患者60例,随机数字法分为两组:A组30例,术后放置宫腔三腔导管负压冲洗引流装置治疗;B组30例术后放置二腔球囊导管治疗。观察时间为术后6个月。比较两组患者术后再粘连率、内膜恢复情况、月经评分及妊娠率。结果:在二次宫腔镜探查时A组有效率为93.3%,B组为83.4%,差异均有统计学意义(P<0.05);再粘连率分别为6.7%及16.7%。术后6个月A组内膜厚度及术后经量评分中位数值均高于B组,差异有统计学意义(P<0.05);术后6个月两组妊娠率差异无统计学意义(P>0.05);两组阴道总引流液量差异有统计学意义(P<0.05),而宫腔感染率、脱管率差异无统计学意义(P>0.05)。结论:宫腔镜下宫腔粘连分离术后应用宫腔三腔导管负压冲洗引流装置相比普通二腔球囊,可降低患者再粘连率,增加患者子宫内膜厚度,改善月经情况。

Application of Three-lumen Catheter Negative Pressure Irrigation and Drainage Device in Uterine Adhesions

Objective:To evaluate the application of three-chamber catheter negative pressure irrigation and drainage device after hysteroscopy for transcervical resection of adhesion(TCRA).Methods:60 patients with moderate to severe intrauterine adhesions diagnosed by hysteroscopy from August 2017 to August 2018 were selected and randomly divided into two groups.In group A,30 patients were treated with three-chamber catheter negative pressure irrigation and drainage device after hysteroscopy for transcervical resection of adhesion(TCRA).In group B,30 patients were treated with two-chamber balloon catheter after the same operation.The observation time was 6 months after operation.Postoperative adhesion rate,endometrial recovery,menstrual score and pregnancy rate were compared between the two groups.Results:The intrauterine effective rate of group A was 93.3%,the re-adhesion rate was 6.7%,the intrauterine effective rate of group B was 83.4%,and the re-adhesion rate was 16.7%.The difference was statistically significant(P<0.05).The median value of endometrial thickness and post-operative menstrual volume score in group A was higher than that in group B at 6 months after operation.The difference was statistically significant.There was no significant difference in pregnancy rate in 6 months after operation(P>0.05).Compared with two-chamber balloon catheter,negative pressure irrigation and drainage device had significant difference in total vaginal drainage flow(P<0.05),but there was no significant difference in uterine infection rate and decannulation rate(P>0.05).Conclusions:The application of three-chamber catheter negative pressure irrigation and drainage device after hysteroscopy for transcervical resection of adhesion(TCRA) can significantly reduce the rate of re-adhesion,increase the thickness of endometrium and improve menstruation.