术后放置防粘连膜加宫内节育器和几丁糖加球囊治疗重度宫腔粘连的疗效比较

目的:比较治疗重度宫腔粘连时,放置Interceed防粘连膜加宫内节育器(IUD)与几丁糖加Foley导尿球囊(48 h后取出并放置IUD)两种治疗方法,对宫腔形态及月经量改善的效果。方法:对2012年9月—2015年11月在清远市妇幼保健院通过宫腔镜检查确诊的84例重度宫腔粘连患者随机分为2组。防粘连膜加IUD组41例,行宫腔镜下宫腔粘连分离术(TCRA),术后放置Interceed防粘连膜加IUD。几丁糖加球囊组43例,TCRA术后宫腔内注入几丁糖、留置Foley导尿球囊48 h后取出,并放置IUD。2组术后第2天均开始口服雌孕激素3个周期,4个月后再次行宫腔镜检查加IUD取出术。结果:2组患者治疗重度宫腔粘连疗效的比较差异有统计学意义(Z=3.780,P0.001)。防粘连膜加IUD组治愈患者较多,占该组病例的56.10%(23/41),有36.59%(15/41)的患者好转;几丁糖加球囊组仅有13.95%(6/43)的患者治愈,69.77%(30/43)的患者好转。2组患者再次宫腔粘连发生率比较差异无统计学意义(χ2=0.036,P=0.850)。防粘连膜加IUD组治疗后增加月经量比几丁糖加球囊组多,差异有统计学意义(t=3.111,P=0.003)。2组患者妊娠率比较差异无统计学意义(χ2=0.403,P=0.526)。结论:TCRA术后联合放置Interceed防粘连膜及IUD,术后给予雌孕激素周期治疗,能有效改善重度宫腔粘连患者宫腔形态及月经恢复情况,比几丁糖加Foley导尿球囊的治疗方式更有效。

Comparison of Anti -adhesion Membrane Plus Intrauterine Device and Chitosan Plus Balloon in Treatment of Severe Intrauterine Adhesions after Transcervical Resection

Objective:To compare the therapeutic effects of two kinds of treatment methods, the interceed anti-adhesion membrane plus intrauterine device (IUD) and the Chitosan plus Foley balloon (placing IUD after 48 hours), on severe intrauterine adhesions after routine transcervical resection. Methods:A total of 84 cases who were diagnosed as severe intrauterine adhesion by hysteroscopy from September 2012 to November 2015 were retrospectively analyzed. They were randomly divided into 2 groups:Group 1 (Interceed plus IUD group, 41 cases) in which placed Interceed and IUD after transcervical resection of adhesions (TCRA), and Group 2 (Chitosan plus balloon, 43 cases) in which after separation of adhesions, injected Chitosan in intrauterine, indwelled Foley balloon (removed after 48 hours) and placed IUD. After 3 cycles of oral estrogen and progesterone treatment in both groups, IUDs were removed with a hysteroscopy on the 4th month. Results:There were significant differences in the cure rates of severe intrauterine adhesions between two groups (Z=3.780, P<0.001). There were 56.10%(23/41) cured cases and 36.59%(15/41) improved cases in the group 1. In the group 2, only 13.95%(6/43) cases were cured, and 69.77% (30/43) cases improved. There was no significant difference in the incidence of intrauterine re-adhesions between the 2 groups (χ2=0.036, P=0.850). The increased menstrual volume after TCRA in the group 1 was more than that in the group 2 (t=3.111, P=0.003). There was no significant difference in the pregnancy rate between the 2 groups (χ2=0.403, P=0.526). Conclusions:With estrogen and progesterone treatment after TCRA, the Interceed anti adhesion membrane plus IUD can effectively improve uterine cavity shape and menstrual volume in those patients with severe intrauterine adhesions, which is better than Chitosan plus Foley balloon.