羊膜球囊治疗重度宫腔粘连对患者子宫内膜厚度、闭经复潮率、月经恢复及感染情况的影响

Effects of amniotic balloon on endometrial thickness,rate of menstruation return,menstruation recovery and infection in treatment of severe intrauterine adhesions

目的观察羊膜球囊治疗重度宫腔粘连的临床疗效对患者子宫内膜厚度、闭经复潮率、月经恢复及感染情况的影响。方法重度宫腔粘连56例,随机分为治疗组与对照组,每组28例,2组患者在术后均抗生素治疗以减少感染症状的发生,入院后在宫腔镜下行分离术,术后对治疗组病患宫腔内放置羊膜球囊,对照组病患放置Foley球囊。比较2组病患月经量评分、宫腔粘连评分、宫腔再粘连发生率;比较治疗前以及治疗后3、6个月时其子宫内膜厚度;比较术后2个月闭经复潮率、月经恢复正常率及感染情况;比较术后随访妊娠等情况。结果与对照组病患相比,治疗组宫腔粘连评分降低更多,月经量评分上升程度更高(P<0.05);在治疗后6个月进行随访,治疗组病患宫腔再粘连发生率低于对照组,病患在治疗后的3个月与6个月的子宫内膜厚度大于对照组(P<0.05);术后2个月治疗组患者闭经复潮率、月经恢复正常率显著高于对照组(P<0.05),治疗组患者的感染率为明显低于对照组(P<0.05);术后随访治疗组妊娠情况优于对照组,但差异无统计学意义(P>0.05)。结论采用羊膜球囊治疗重度宫腔粘连患者能显著缓解病情,且术后宫腔再粘连发生率低、月经量评分上升程度较高,子宫内膜的厚度也增大,在一定程度上改善妊娠情况,此治疗方案在临床上应用价值高,值得推荐使用。

Objective To explore the effects of amniotic balloon on endometrial thickness,rate of menstruation return,menstruation recovery and infection in the treatment of severe intrauterine adhesions（IUA）. Methods Fifty six patients with severe IUA were randomly divided into treatment group（n = 28） and control group（n = 28）. Transcervical resection of adhesion（TCRA） under hysteroscope was performed on all patients after admission. After operation,all patients were treated by antibiotics to reduce the incidence of infection. Amniotic balloon and Foley balloon were placed in the uterine cavities of the patients in treatment group and control group,respectively. The scores of menstrual volume and intrauterine adhesions,the incidences of re-adhesion were compared between the two groups. Moreover,the endometrial thickness before treatment and at 3 and 6 mon after treatment were compared between the two groups. In addition,the rate of menstruation return and menstruation recovery,infection at 2 mon after operation as well as follow-up pregnancy of the patients were compared between the two groups. Results The scores of IUA of patients in treatment group were significantly decreased,as compared with those in control group,however,the scores of menstrual blood volume were significantly increased. The incidence of re-adhesion of patients in treatment group was lower than that in control group. The endometrial thickness at 3 m and 6 m after treatment was thicker in treatment group than that in control group（P〈0. 05）. Moreover,the amenorrhea recovery rate and menstruation recovery normal rate at 2 m after operation in treatment group were significantly higher than those in control group（P〈0. 05）. In addition,the infection rate in treatment group was significantly lower than that in control group（P〈0. 05）,and the pregnancy status of patients in treatment group was better than that in control group,but there was no significant differnce between two groups（P〈0. 05）. Conclusion Amniotic balloon is effective in treating severe IUA,which can significantly alleviate the disease condition,with a lower incidence of re-adhesion and a higher score of menstrual volume. In addition,the endometrial thickness is increased and the pregnancy status is improved,therefor,it is worthy of application and popularization in clinical practice.