生物蛋白胶在宫腔镜下宫腔粘连分离术后预防再次粘连的价值

Efficacy of bioprotein gel in preventing the development of intrauterine adhesions following hysteroscopic adhesiolysis

目的探讨宫腔镜指引下宫腔粘连(intrauterine adhesion,IUA)机械分离术后放置生物蛋白胶对防止术后再粘连的价值。方法2005年3月～2007年8月就诊于该院经宫腔镜诊断为各级IUA的患者66例。全部患者按就诊顺序随机分为A、B、C3组。每组22例。A组为治疗组(粘连分离后宫腔内放置生物蛋白胶),B组为IUD对照组(粘连分离后宫腔内放置金属圆形IUD),C组为空白对照组。手术时间选择在月经干净后3～5d。全部患者于术前第4天开始晚饭前2h口服米非司酮50mg,连续3d。术前日早、晚8点分别于阴道内放置卡孕栓1mg,次日在CSEA麻醉下实施手术。结果术后3个月复查及宫腔镜二次探查表明:A组病例术后再粘连的发生率极显著低于B组及C组(P=0.001),术后月经好转及术后宫腔恢复正常者明显高于B组及C组(P=0.040,P=0.001)。结论经过药物预处理后宫腔镜指引下的宫腔粘连机械性分离术是一种即安全、简便,又效果良好的手术方法,避免了能源性分离手术给子宫内膜及肌壁造成的损伤。术后宫腔内留置生物蛋白胶很有效地防止了再粘连的发生,使手术治愈率得以明显提高。

【Objective】A prospective, randomized, controlled study was performed to assess the efficacy of bio- protein gel in preventing the development of intrauterine adhesions following hysteroscopic adhesiolysis. 【Methods】 66 patients with intrauterine adhesions were admitted to our hospital. Patients were randomized to 3 different groups. Group A were randomized to mechanical adhesiolysis under hysteroscope plus intrauterine application of bioprotein gel. Group B were randomized to mechanical adhesiolysis plus in...