重度宫腔粘连宫腔镜分离术后防止宫腔再粘连方法的比较

Comparative study on methods about prevention of intrauterine re-adhesions after hysteroscopic surgery for intensive intrauterine adhesions

目的 探讨重度宫腔粘连(intrauterine adhensions,IUA)行宫腔镜下宫腔粘连分解术(transcervical resection of adhensions,TCRA)后预防宫腔再粘连的措施。方法 回顾性分析2007年5月至2010年11月宝鸡市妇幼保健院妇科内镜诊治中心住院治疗的123例患者的临床资料,其粘连程度均经宫腔镜检查确诊为重度宫腔粘连。A组54例,术后宫腔置入"O"型金属宫内节育器(intrauterine contraceptive device,IUD)并注入透明质酸钠2ml;B组69例,术后宫腔置入"O"型金属IUD并注入透明质酸钠2ml且联合明胶海绵填塞宫颈管。两组术后均给予抗生素预防感染和人工周期治疗3月;术后1、3、9个月均门诊宫腔镜复查,观察术后宫腔形态恢复情况及月经改善情况。结果 宫腔再粘连率B组低于A组(P<0.05),月经改善率B组优于A组(P<0.05)。结论 宫腔内放置IUD并注入透明质酸钠且联合填塞明胶海绵条可有效预防宫腔镜电切术后再粘连,提高月经正常率。

Objective To study the prevention of adhesion recurrence after hysteroscopic management for severe intrauterine adhesion（IUA）. Methods Clinical data of 123 patients who were confirmed as severe IUA by hysteroscopy between May 2007 and November 2010 in Baoji Hospital of Women and Children diagnosed in Gynecological Endoscopy Center were retrospectively analyzed. Patients were divided into two groups according to the different therapy methods. Fifty -four cases in Group A were inserted ＂ O＂ type metal IUD and taken sodium hyaluronate 2 ml in uterine after the operations; 69 cases in Group B were inserted ＂ O＂ type metal IUD, taken sodium hyaIuronate 2 ml in uterine and gelatin sponge stuffiness cervical tube cavity after the operations. All cases in two groups were given antibiotics to prevent infection and artificially cycle treatment after the operation. The situation of intrauterine cavity recovery and menstrual improvement of outpatient was observed after the operation of 1, 3, 9 months. Results The adhesions recurrence rate was significant higher （ P 〈 0.05 ） in Group A compared to Group B. The improving rate of menses in Group A was significant lower （ P 〈 0. 05 ） than that in Group B. Conclusion The measures of IUD inserted, sodium hyaluronate in uterine and gelatin sponge stuffiness cervical tube cavity taken after hysteroscopie surgery is an effective method in preventing adhesion recurrence and improving menses rate.