Cook球囊预防宫腔粘连术后复发有效性评估

Effectiveness Evaluation of Long-term Placement of Cook Balloon Uterine Stent for Preventing Postoperative Intrauterine Adhesion Reforming

目的:探讨长时间放置cook球囊预防宫腔粘连术后复发的有效性评估。方法:收集自2014年8月至2015年8月在我院就诊并经宫腔镜检查确诊为中、重度宫腔粘连,近期有生育要求者并愿意治疗、参与随访的患者158例,抽签法随机分为两组:IUD组66例,球囊组92例。术后三月二探时再次对其进行分级,并随访妊娠情况。结果:长时间放置cook球囊较IUD预防宫腔再粘连更有效(100%vs 83.87%,P<0.05),有更高的累计妊娠率(47.37%vs 30.65%,P<0.05)。球囊组术后经量评分中位数值稍高于IUD组,但无统计学差异(P>0.05)。IUD组中有4例患者术后发现宫颈管再粘连,球囊组未见宫颈管粘连者。结论:中重度宫腔粘连术后宫腔内长时间放置cook球囊较IUD在预防术后宫腔再粘连、宫颈管粘连、远期生育结局方面效果较佳。

Objective：To evaluate the value of balloon uterine stent placement in the uterus for 3 months as prevention of adhesion recurrence. Methods：Totally 158 patients who were diagnosed for moderate or severe intrauterine adhesions during August 2014 to August 2015 in Sun Yat-sen Memorial Hospitalwith recent fertility requirements and werewilling to participate in treatment and follow-up were collected.All patients were randomly divided into two groups：intrauterine devicegroup for 66 cases,92 cases of balloon group. Hysteroscopic second-look was conducted in all patients while the stents were removed after three cycles of withdraw bleeding. Patients were followed up for the situation of adhesion recurrence,menstruation volume,complications and pregnancy. Results：The effective rateand cumulative pregnancy rate in the balloon group were significantly higher than those of IUD group（100% vs83.87%,47.37%vs30.65%,P〈0.05）. Although postoperative PBAC scores in the balloon group had higher score than IUD group,there was no significant difference between two groups（55.5 vs 50,P〉0.05）. 4 patients of IUD group were found amenorrhea because of cervical canal adhesion,while no cases like this was found in balloon group. Conclusion：The long-term placement of balloon uterine stent in the uterus is more effective in preventing postoperative adhesions and has higher cumulative pregnancy rate in patients with moderate to severe intrauterine adhesion than IUD.