透明质酸联合置环对宫腔镜下重度宫腔粘连分离术后再次粘连的预防作用

Preventive effect of hyaluronic acid combined with intrauterine device on re-adhesion after hysteroscopic adhesiolysis for severe intrauterine adhesion

目的探讨透明质酸联合置环对宫腔镜下重度宫腔粘连(IUA)分离术后再次粘连的预防作用。方法将行IUA分离术的120例重度IUA患者随机分为研究组60例和对照组60例,两组患者均常规行IUA分离术;对照组置入气囊+置环,研究组在对照组基础上注入透明质酸;术后3个月进行评价,比较两组患者疗效、再次粘连率、月经改善率和妊娠率,并对两组患者治疗前后子宫内膜厚度进行评价。结果研究组术后3个月检查宫腔无明显粘连,对照组节育器间隙中仍有部分粘连;研究组总有效率为98.33%,显著高于对照组(86.67%),差异具有统计学意义(χ2=9.698,P<0.05);术后3个月研究组月经改善率为90.00%,显著高于对照组(78.33%),差异具有统计学意义(P<0.05);术后6个月研究组妊娠率为48.33%,对照组为33.33%,研究组妊娠率亦显著高于对照组,差异有统计学意义(P<0.05);术后3个月两组患者子宫内膜均明显增厚,与治疗前相比差异具有统计学意义(P<0.05);两组治疗后子宫内膜厚度相比差异无统计学意义(P>0.05)。结论透明质酸联合置环能够有效预防重度IUA分离术后再次粘连,提高妊娠率和月经改善率,值得临床推广应用。

Objective To explore the preventive effect of hyaluronic acid combined with intrauterine device on re- adhesion after hysteroscopic adhesiolysis for severe intrauterine adhesion（ IUA）. Methods One hundred and twenty severe IUA patients were randomly divided into study group and control group,sixty patients in each group. Hysteroscopic adhesiolysis for severe IUA was conducted in the two groups routinely; the cases in control group were treated with airbag and intrauterine device,on the basis of control group,the cases in study group were treated with injection of hyaluronic acid; the cases in the two groups were evaluated at 3 months after surgery; the curative effects,re- adhesion rates,menstrual improvement rates,and pregnancy rates in the two groups were compared; endometrial thicknesses before and after treatment in the two groups were evaluated. Results At three months after surgery,no obvious IUA was found in study group,partial adhesion was found between intrauterine cavity and intrauterine device; the total effective rate was 98. 33% in study group,which was statistically significantly higher than that in control group（ 86. 67%）（ χ2= 9. 698,P〈0. 05）. The menstrual improvement rate at three months after surgery in study group was 90. 00%,which was statistically significantly higher than that in control group（ 78. 33%）（ P〈0. 05）; the pregnancy rates at six months after surgery in study group and control group were 48. 33% and 33. 33%,respectively,the pregnancy rate at six months after surgery in study group was statistically significantly higher than that in control group（ P〈0. 05）; at three months after surgery,endometrial thicknesses in the two groups increased significantly,compared before treatment,there were statistically significant differences（ P〈0. 05）; there was no statistically significant difference in endometrial thickness after surgery between the two groups（ P〈0. 05）. Conclusion Hyaluronic acid combined with intrauterine device can effectively prevent re- adhesion after hysteroscopic adhesiolysis for patients with severe IUA,improve pregnancy rate and menstrual improvement rate,the method is worthy of clinical promotion and application.