宫腔镜下子宫内膜息肉电切术后预防宫腔粘连的研究

Psotoperative prevention of intrauterine adhesion after hysteroscopic endometrial polyp electrocision

目的探讨宫腔镜下子宫内膜息肉电切术后预防宫腔粘连的安全性与有效性。方法所有患者均在宫腔镜下电切完成手术,手术时间20～30 min,出血量10～30 ml,电切术后宫腔内放置Foley球囊尿管,留置6～7 d后拔除,可有效预防宫腔粘连。结果本研究1～3年随访83例,失访6例,随访率为93%。随访时绝经20例,月经量明显减少12例,51例生育年龄患者恢复月经周期、经量规律正常,且其中22例顺利妊娠并足月分娩。所有随访患者经腹部和阴道超声检查均无息肉复发及宫腔粘连发生。结论宫腔镜下子宫内膜息肉电切术的同时宫腔内放置Foley球囊尿管有利于宫腔内积血、积液、炎性分泌物经尿管口充分引流,减少了感染的几率;充气的球囊在宫腔内起支架作用,可有效地促进内膜的修复,是预防宫腔粘连安全而有效的治疗方法,值得临床推广应用。

Objective To study the safety and effect of postoperative prevention of intrauterine adhesion after hysteroscopic endometrial polyp electrocision.Methods All the patients were performed with operation under hysteroscope electrotomy,the operation time was 20-30 min,bleeding volume was 10-30 ml.Foley uterine balloon catheter indwelling was placed after electric resection,and was removed after 6-7 d,can be effective in the prevention of intrauterine adhesions.Results There were 83 patients underwent 1 to 3 years follow-up,6 cases were lost to follow-up,the follow-up rate was 93%.Twenty patients with menopause,menstrual volume significantly decreased in 12 patients,51 cases of child-bearing age patients had resumption of the menstrual cycle,the rule of normal,and at the same time,smooth delivery at term pregnancy（n=22）.All patients were treated with abdominal and transvaginal ultrasound examination,and there was no recurrence of polyps,or intrauterine adhesions occur.Conclusion Hysteroscopic endometrial polyp electrocision and Foley balloon catheter intrauterine placed,is conducive to the intrauterine hematocele,effusion,inflammatory secretions by catheter mouth full drainage,so reduce the chance of infection;an inflatable balloon in the palace cavity play a support role can effectively promote endometrial repair,is a safe and effective method for prevention of intrauterine adhesions,worthy of clinical application.