可吸收防粘连膜及宫腔支撑球囊联合应用在中重度宫腔粘连术后的治疗效果观察

Clinical effect of absorbable medical film combined intrauterine balloon to prevent re-adhesion after trans-cervical resection of adhesions

目的探讨可吸收防粘连膜及宫腔支撑球囊联合应用在中重度宫腔粘连的治疗效果。方法 2016年1~12月四川省人民医院收治的49例中重度宫腔粘连患者,均行宫腔镜下宫腔粘连分离术(TCRA),术中根据中国宫腔粘连诊断分级评分标准进行评分,术后用雌孕激素疗法3个周期(戊酸雌二醇4 mg/d共21天,后10天加用地屈孕酮10 mg bid)。根据术后处理方法分成3组:A组(14例)放置防粘连膜;B组(14例)放置宫腔支撑球囊及防粘连膜;C组(21例)放置宫腔支撑球囊。术后3个月均行二次宫腔镜探查,根据中国宫腔粘连诊断分级评分标准再次进行评分。结果 3个月后复查宫腔镜,三组患者宫腔镜粘连评分比较差异有统计学意义(P<0.01),B组(防粘连膜+宫腔支撑球囊)效果最佳。三组患者术后子宫内膜厚度及月经量均有明显改善(P<0.01)。结论 TCRA术后同时放置防粘连膜及宫腔支撑球囊在中重度宫腔粘连的预防术后复粘方面有较好的效果。

To investigate the clinical effect of absorbable medical film and intrauterine balloon to prevent the re-adhesion after trans-cervical resection of adhesions.Clinical data of 49 cases which diagnosed moderate or severe intrauterine adhesion in our hospital from Jan 2016 to Dec 2016 were collected.All patients underwent trans-cervical resection of adhesions(TCRA).The grading criteria were evaluated according to the Chinese guideline.All patients received three cycle treatment of estrogen and progesterone(estradiol valerate 4 mg/day for 21 days followed by dydrogesterone 10 mg,bid for 10 days).The patients were divided into three groups according to the postoperative treatment:group A(n=14)was installed with absorbable medical film,group B(n=14)was installed with absorbable medical film and intrauterine balloon and group C(n=21)was installed with intrauterine balloon.Three months later,a hysteroscopy was performed.All patients evaluated again according to the Chinese guideline.There were significant differences in the second score after three months(P<0.01).The effect of the group B was the best.All three groups endometrial thickness and menstrual volume were significantly improved after surgery.Installed absorbable medical film and intrauterine balloon together after TCRA have good effect to prevent the re-adhesion after the operation in patients with moderate or severe intrauterine adhesion.