中重度宫腔粘连宫腔镜手术后预防再次粘连的三种方法疗效比较

目的:探讨中重度宫腔粘连宫腔镜手术后应用透明质酸钠联合COOK球囊与宫内节育器预防再次粘连的疗效比较。方法:回顾分析2015年3月至2019年3月67例行宫腔镜下宫腔粘连分离术患者的相关临床资料,根据手术后预防再粘连的方法分为A组(宫腔内放置透明质酸钠)与B组(宫腔内放置宫内节育器与透明质酸钠)、C组(宫腔内放置COOK球囊与透明质酸钠),比较3组术后宫腔再粘连及月经情况。结果:3组患者术后3个月、6个月复检,宫腔粘连情况(F=3.707,P=0.030;F=5.266,P=0.008)、月经情况(F=4.648,P=0.013;F=4.373,P=0.017)差异有统计学意义(P<0.05),A、B两组差异无统计学意义(P>0.05);A、C两组及B、C两组相比差异有统计学意义(P<0.05)。结论:宫腔粘连分离术后宫腔放置COOK球囊联合透明质酸钠的综合治疗方案能有效预防中重度宫腔粘连术后再粘连的发生,有效改善患者月经,较单独使用一种方法更有效。加用宫内节育器并不能更好的改善术后宫腔再粘连的发生。

Efficacy comparison of three methods for prevention of re-adhesion after hysteroscopic surgery for moderate and severe intrauterine adhesions

Objective:To compare the efficacy of sodium hyaluronate combined with COOK balloon and intrauterine device(IUD)in preventing re-adhesion after transcervical resection of adhesions(TCRA)for moderate and severe intrauterine adhesions(IUA).Methods:From Mar.2015 to Mar.2019,the clinical data of 67 patients who underwent TCRA were retrospectively analyzed.According to different methods of preventing re-adhesions after TCRA,the patients were divided into group A(intrauterine placement of sodium hyaluronate),group B(intrauterine placement of IUD and sodium hyaluronate)and group C(intrauterine placement of COOK balloon and sodium hyaluronate).The postoperative re-adhesion and menstruation were compared among the three groups.Results:According to the re-examination of three months and six months after TCRA in three groups,the difference of IUA(F=3.707,P=0.030;F=5.266,P=0.008)and menstruation(F=4.648,P=0.013;F=4.373,P=0.017)was statistically significant;There was no significant difference of IUA or menstruation between groups A and B at three or six months(P>0.05),there were significant differences between groups A and C as well as groups B and C(P<0.05).Conclusions:After the TCRA,the combined treatment of COOK balloon and sodium hyaluronate in uterine cavity can effectively prevent the recurrence of moderate and severe IUA,and effectively improve the menstruation of patients,this procedure is more effective than using one method alone.IUD cannot improve the incidence of intrauterine re-adhesion after TCRA.