宫腔冲洗引流在中重度宫腔粘连术后的应用

Study on the application of uterine cavity irrigation for moderate and severe intrauterine adhesions

目的评价宫腔冲洗引流在宫腔粘连分离术后应用的临床效果。方法选取2019年在郑州大学第三附属医院就诊的中重度宫腔粘连患者92例作为研究对象,根据术后预防再粘连方法的不同分为2组:A组46例(中度粘连30例、重度粘连16例),术后放置三腔球囊导管,并于术后即刻和术后48 h采用生理盐水行宫腔冲洗引流;B组46例(中度粘连29例、重度粘连17例),术后放置二腔球囊导管引流。比较2组患者宫腔引流量、不良反应发生率、术后内膜厚度、月经恢复情况及术后1年内的妊娠情况。结果治疗后A组子宫内膜厚度(6.00±1.56)mm、月经改善率86.96%,均高于B组,差异具有统计学意义(P<0.05)。其中,中度宫腔粘连患者A组术后子宫内膜厚度、月经恢复率均高于B组,差异具有统计学意义(P<0.05);重度宫腔粘连患者两组子宫内膜厚度、月经改善情况差异无统计学意义(P>0.05)。A组宫腔引流液量(2.91±1.49)ml,低于B组,差异具有统计学意义(P<0.05),A、B两组不良反应差异比较无统计学意义(P>0.05),A、B两组术后妊娠率分别为41.30%、30.43%,差异无统计学意义(P>0.05)。结论宫腔镜宫腔粘连分离术术后行宫腔冲洗可有效促进中度宫腔粘连患者的内膜恢复,有助于降低宫腔再粘连率,更好地改善月经情况,但对重度宫腔粘连患者的临床疗效提升不明显。

Objective To evaluate the clinical effect of intrauterine irrigation and drainage after separation of intrauterine adhesion.Methods A total of 92 patients with moderate and severe intrauterine adhesion treated in the Third Affiliated Hospital of Zhengzhou University were selected as the research object in 2019.According to the different methods of postoperative prevention of re-adhesion,they were divided into two groups:46 cases in group A(30 cases of moderate adhesion and 16 cases of severe adhesion),three lumen balloon catheter was placed after operation,and normal saline was used for intrauterine flushing and drainage immediately and 48 hours after operation;46 cases in group B(29 cases of moderate adhesion and 17 cases of severe adhesion)were placed with two lumen balloon catheter for drainage after operation.The uterine drainage volume,incidence of adverse reactions,postoperative intimal thickness,menstrual recovery and pregnancy within 1 year were compared between the two groups.Results After treatment,the endometrial thickness and menstrual improvement rate in group A were(6.00±1.56)mm and 86.96%,respectively,which were statistically higher than those in group B(P<0.05).Among them,for patients with moderate intrauterine adhesion,the postoperative endometrial thickness and menstrual recovery rate in group A were higher than those in group B(P<0.05);difference in endometrial thickness and menstrual improvement between the two groups was not statistically significant(P>0.05).The amount of uterine drainage fluid in group A was(2.91±1.49)ml,which was statistically lower than that in group B(P<0.05).There was no statistically significant difference in adverse reactions between groups A and B(P>0.05).The postoperative pregnancy rates in groups A and B were 41.30%and 30.43%,respectively(P>0.05).Conclusion Hysteroscopic uterine cavity adhesion separation and postoperative uterine cavity flushing can effectively promote the intimal recovery of patients with moderate uterine cavity adhesion,help to reduce the rate of uterine cavity re-adhesion,and better improve menstruation,but the clinical effect on severe uterine cavity adhesion is not obvious.