医用几丁糖预防宫腔再粘连的临床分析

目的 探讨医用几丁糖在宫腔粘连分离术后预防宫腔再粘连的临床效果.方法 2011年3月-2013年4月宫腔镜下宫腔粘连分离术112例,根据术后防粘连的方法不同分为研究组和对照组：研究组61例,术后宫腔内放置医用几丁糖2.5 ml及元宫环1枚,术后联合人工周期治疗（戊酸雌二醇3 mg每12 h口服1次,共21 d,最后10 d加用安宫黄体酮6 mg,1次/d,口服）;对照组51例,术后宫腔内放置元宫环1枚,术后用药同研究组.比较2组术后再粘连发生率.结果 2组轻度粘连患者术后均未见宫腔粘连复发.中度宫腔粘连患者分离术后复发率研究组13.9%（5/36）显著低于对照组36.7%（11/30）（Z=-2.134,P=0.033）.重度宫腔粘连患者分离术后复发率研究组66.7%（6/9）与对照组88.9%（8/9）无统计学差异（Z=-1.102,P=0.270）.重度粘连患者二次宫腔镜下粘连分离术后宫腔镜检查,研究组2例存在粘连,对照组7例,有统计学差异（Z=-2.017,P=0.044）.结论医用几丁糖能有效预防中、重度宫腔粘连患者的术后复发.

Medical Chitosan for Preventing Readhesion after Hysteroscopic Lysis of Intrauterine Adhesions

Objective To explore the effect of medical chitosan on preventing adhesion recurrence after hysteroscopic lysis of intrauterine adhesions. Methods A total of 112 cases of intrauterine adhesions confirmed by hysteroscopy underwent hysteroscopic lysis of intrauterine adhesions from March 2011 to April 2015. They were divided into two groups according to the method of adhesion prevention following hysteroscopic lysis. In the research group： 61 patients were placed medical chitosan and intrauterine device （IUD） at the end of the procedure, and treated by artificial menstrual cycle （oral progynova was given 3 mg every 12 h for 21 d and provera was added for the last 10 d by 6 mg daily） after operation. In the control group： 51 patients were inserted IUD at the end of the procedure, and treated by artificial menstrual cycle（ the same as the research group） after operation. Readhesion rate was compared between the two groups. Results No adhesion after adhesiolysis was found in patients with mild adhesions in both groups. Adhesion recurrence rate of patients with moderate adhesions in the research group was 13.9% （5/36）, significantly lower than that in the control group （36.7% , 11/30, Z = -2. 134, P = 0. 033） , while no significant difference in adhesion recurrence rate of patients with severe adhesions was found between the two groups 66.7% （6/9） vs. 88.9% （8/9）, Z = - 1. 102, P = 0. 270 ]. After secondary adhesiolysis in patients with severe adhesions, there were 2 and 7 cases of adhesions in the research and control group respectively （Z = -2. 017, P = 0. 044）. Conclusion Medical chitosan could effectively prevent adhesion recurrence of patients with moderate and severe adhesions.