置入防粘连膜与否在中重度宫腔粘连治疗中的效果比较

The efficacy of absorbable adhesion barrier in the treatment of moderate or severe intrauterine adhesions

目的探讨分析宫腔镜下行宫腔粘连分离术(TCRA)后联合使用宫内节育器(IUD)、大剂量雌激素与加用防粘连膜(Interceed)综合治疗方法治疗中重度宫腔粘连的临床效果。方法 58例中、重度宫腔粘连患者,随机分成A、B两组。A组行TCRA并放置IUD,术后口服大剂量戊酸雌二醇(E2V)5 mg/次,每12 h 1次,行人工周期治疗,后10 d加服安宫黄体酮片(MPA)10 mg/d;B组行TCRA并放置IUD的同时于宫腔内放置Interceed,术后雌激素治疗同A组。监测患者服E2V前和加服MPA前子宫内膜厚度,3个月后再次行宫腔镜检查术,评估宫腔粘连的治疗效果。结果 B组的完全治愈率及治疗总有效率明显优于A组(P<0.05)。对比两组治疗方案治疗前后子宫内膜厚度增长情况均差异有统计学意义(P<0.05)。结论加用Interceed的综合治疗方法对预防TCRA后宫腔再粘连的疗效优于未加用Interceed。大剂量雌激素的使用可增加中重度IUA的子宫内膜厚度。

Objective To investigate the clinical efficacy of absorbable adhesion barrier （Interceed） in transcer- vical resection of adhesions （TCRA） combined with intrauterine device （IUD）, high dose estrogen on treatment of moder- ate or serious intrauterine adhesions. Methods Fifty - eight cases with moderate or serious intrauterine adhesion were randomly divided into 2 groups, Group A （IUD with TCRA and oral estrogen treatment） and Group B （ IUD with TCRA, oral estrogen treatment and Interceed）. The endometrial thickness before oral E2V and MPA were recorded. Reoperation of hysteroscopy was performed to evaluate the treatment efficacy 2 or 3 months after treatment. Results The cure rate and effective rate in Group B were significantly higher than those in Group A （ P 〈 0. 05 ）. The endometrial thickness was sig- nificantly thickened in both groups （ P = 0. 000）. Conclusion Comprehensive treatment combined with Interceed provides better efficacy on the prevention of second intrauterine adhesion after TCRA. High dose estradiol valerate can promote the growth of endometrium with moderate or severe intrauterine adhesions.