两种宫腔屏障用于宫腔粘连术后的临床效果观察

目的 探讨两种宫腔屏障用于中重度宫腔粘连(intrauterine adhesion,IUA)行宫腔镜下宫腔粘连分离术(transcervical resection of adhesions,TCRA)后的临床效果.方法 选取2016年1月至2016年6月湖北省妇幼保健院收治的中重度宫腔粘连患者52例,按术后构建宫腔屏障方法的不同按随机数字表法分为两组.观察组:术毕宫腔放置Foley球囊+自交联透明质酸钠凝胶,术后1d取出球囊,1周后宫腔镜探查并再次注入自交联凝胶;对照组:术毕放置Foley球囊+普通医用透明质酸钠凝胶,术后1周取出球囊,宫腔镜探查,置入宫内节育器及普通透明质酸钠凝胶.所有患者均行人工周期治疗.观察术后3月各组宫腔粘连AFS评分及治疗有效率、宫腔再粘连率.结果 两组患者术后3个月时AFS总分和粘连范围、粘连类型、月经状况单项评分均较术前明显下降,差异均有统计学意义(P＜0.05).两组间比较,观察组AFS总分、月经状况评分、再粘连率均低于对照组,治疗有效率高于对照组,差异均有统计学意义(P＜0.05).结论 TCRA术后应用Foley球囊+自交联透明质酸钠凝胶作为宫腔屏障,是提高IUA疗效的有效方法.

Clinical effect of 2 kinds of barriers for intrauterine adhesion by hysteroscopic surgery

Objective To investigate the clinical effect of 2 kinds of intrauterine barriers for the patients with moderate to severe intrauterine adhesion (IUA) after hysteroscopic transcervical resection of adhesions (TCRA).Methods A total of 52 patients with moderate to severe IUA undergoing TCRA via hysteroscopy in our hospital from January 2016 to June 2016 were enrolled in the study.They were randomly divided into 2 groups according to various intrauterine barriers.In the observation group,Foley balloon catheter and crosslinked sodium hyaluronate gel were introduced into uterine after operation,and then the catheter was pulled out on the next day.Second-look hysteroscopic examination was performed at a week later and auto-crosslinked sodium hyaluronate gel was given to uterine again at the same time.In the control group,the Foley balloon catheter and common medical sodium hyaluronate gel were introduced into the uterine after operation.Second-look hysteroscopy was also performed and the catheter was also pulled out at a week later,meanwhile,an intrauterine device was given to uterine.Artificial cycle treatment and monthly second-look hysteroscopy was performed for all patients.At 3 months postoperatively,all cases were assessed for the shape of uterus cavity and menstruation,the severity of IUA by American Fertility Society (AFS) classification,treatment efficacy and recurrence of IUA.Results The total AFS score,scores of adhesive range and type,and menstrual pattern in 3 months were significantly lower than before operation in both groups (P ＜ 0.05).The total AFS score,menstrual pattern and rate of re-adhesion were significantly lower in the observation group than the control group,and the effective rate was significantly higher (P ＜ 0.05).Conclusion Foley balloon catheter and auto-crosslinked sodium hyaluronate gel as intrauterine barrier after TCRA is an optional approach for IUA treatment.