宫腔内持续放置水囊联合雌激素预防宫腔粘连分离术后再粘连的研究

Research of Continuous Placement of Intrauterine Placement of Water Sac Combined with Estrogen in Prevention of Re Adhesion after Transcervical Resection of Adhesion

目的探讨宫腔内持续放置水囊联合雌激素预防宫腔粘连分离术后再粘连的效果。方法选取我院自2015年5月—2017年5月间收治的宫腔粘连(Intrauterine Adhesions,IUA)患者90例进行课题研究,随机分为对照组和观察组,每组各45例。两组均采用宫腔粘连分离术(Transcervical Resection of Adhesion,TCRA)治疗,对照组术后使用宫腔内持续放置水囊+宫腔内注射生理盐水治疗,观察组在对照组的基础上口服大剂量雌激素治疗,对比两组患者子宫内膜厚度和凝血功能情况,随访1年记录两组患者再粘连发生率、月经恢复正常率和妊娠率情况。结果治疗前两组患者子宫内膜厚度、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)指标差异无统计学意义(P>0. 05);治疗后观察组患者子宫内膜厚度低于对照组(P <0. 05),APTT和FIB指标组间差异无统计学意义。随访1年,观察组患者再粘连发生率略低于对照组;月经恢复正常率、妊娠成功率观察组高于对照组(P <0. 05)。结论宫腔内持续放置水囊联合雌激素预防TCRA术后再粘连效果显著,可以改善患者子宫内膜厚度,促进月经恢复,提高妊娠成功率,值得推广。

Ojbective To probe into the effects of continuous placement of intrauterine placement of water sac combined with estrogen in prevention of re adhesion after transcervical resection of adhesion.Methods90cases of intrauterine adhesions(IUA)patients admitted to our hospital from May2015to May2017were selected and randomly divided into two groups,45in each group.The two groups were treated with Transvaginal Resection of Adhesion(TCRA).The control group was treated with intrauterine continuous water balloon+intrauterine injection of normal saline.The observation group received oral high-dose estrogen therapy on the basis of the control group.Water sac+high-dose estrogen treatment,comparing the endometrial thickness and coagulation function of the two groups of patients,follow-up1year to record the incidence of re-adhesion,normal menstruation and pregnancy rate.Results There was no significant difference in the thickness of endometrium,activated partial thromboplastin time(APTT)and fibrinogen(FIB)between two groups before treatment(P>0.05).After the treatment,the endometrial thickness in the observation group was lower than that in the control group(P<0.05),and there was no significant difference in the APTT and FIB index between the groups.After follow-up for1years,the incidence of re adhesion in the observation group was slightly lower than that in the control group,and the recovery rate of menstruation and pregnancy success rate in the observation group were higher than those in the control group(P<0.05).Conclusion The effects of intrauterine placement of water sac combined with estrogen in prevention of re adhesion after TCRA are significant,which can improve endometrial thickness,promote menstrual recovery and improve pregnancy success rate,thus it is worth promoting.