宫腔球囊与宫内节育器在宫腔粘连术后疗效比较

Clinical effect of intrauterine balloon versus intrauterine device after transcervical resection of adhesions

目的:探讨宫腔球囊及宫内节育器(intrauterine device,IUD)在宫腔粘连电切术(transcervical resection of uterine adhesions,TCRA)后辅助治疗的临床效果。方法:选取2014年8月至2016年7月在我科确诊为宫腔粘连并实施TCRA且术后仅选择宫腔球囊或宫内节育器一种屏障措施的共计80例患者纳入研究。其中TCRA术后采用宫腔球囊预防再粘连的患者24例,采用宫内节育器的患者56例。所有患者均在3个月内再次行第二次宫腔镜检查。结果:2组患者在年龄、妊娠相关刮宫次数、治疗前美国生育协会(American Fertility Association,AFS)评分、月经、粘连程度以及术后随访时间等方面无统计学差异(P>0.05)。2组患者在治疗后的月经恢复情况无统计学差异(P>0.05),宫腔球囊组术后妊娠率、活产率分别为13/24(54.2%)、2/24(8.33%),IUD组术后妊娠率、活产率分别为27/56(48.2%)、12/56(21.42%),2组比较无统计学差异(P>0.05)。但2组患者在第二次宫腔镜术前AFS评分(2.50±2.41 vs. 1.06±1.65)、术后妊娠时间(11.23±6.93 vs. 6.89±4.39)、宫腔形态恢复等方面比较有统计学差异(P<0.05)。结论:IUD作为TRCA术后的防粘连屏障与宫腔球囊相比在改善术后AFS评分、缩短妊娠时间及促进宫腔形态恢复方面更有优势,宫腔球囊在TRCA术后的实际使用方法上值得进一步探讨。

Objective:To investigate the clinical effect of intrauterine balloon versus intrauterine device(IUD) as an adjuvant therapy after transcervical resection of adhesions(TCRA). Methods:A total of 80 patients who were diagnosed with intrauterine adhesion and underwent TCRA in our department from August 2014 to July 2016 and selected intrauterine balloon or IUD as a barrier after surgery were enrolled. Among these patients,24 used intrauterine balloon to prevent readhesion after TCRA,and 56 used IUD. All patients underwent hysteroscopy again within three months after initial hysteroscopy. Results:There were no significant differences between the two groups in age,number of times of pregnancy-related curettage,American Fertility Association(AFS) score before treatment,menstruation,degree of adhesion,and postoperative follow-up time(P >0.05). There was no significant difference in recovery of menstruation between the two groups after treatment(P >0.05). The intrauterine balloon group had a pregnancy rate of 54.2%(13/24) and a live birth rate of 8.33%(2/24),and the IUD group had a pregnancy rate of 48.2%(27/56) and a live birth rate of 21.42%(12/56);there were no significant differences between the two groups(P >0.05). There were significant differences between the two groups in AFS score before the second hysteroscopy(2.50±2.41 vs. 1.06±1.65,P<0.05),time to pregnancy after surgery(11.23±6.93 vs. 6.89±4.39,P<0.05),and recovery of uterine morphology(P<0.05). Conclusion:As the anti-adhesion barrier after TRCA,IUD is advantageous over intrauterine balloon in improving postoperative AFS score,shortening the time to pregnancy,and promoting the recovery of uterine morphology. The method for the application of intrauterine balloon after TRCA needs further discussion.