中重度宫腔粘连患者宫腔镜术后二次探查的临床价值

Clinical value of secondary exploration after hysteroscopic operation in patients with moderate to severe intrauterine adhesions

目的探讨中重度宫腔粘连患者宫腔镜术后二次探查的临床价值。方法选取我院2015年1月~2017年1月接收的50例中重度宫腔粘连患者作为此次研究对象,入院确诊后均行宫腔镜下宫腔粘连分解术(TCRA),按照随机数字表法将其分为对照组与观察组,各25例,两组术后人工周期连续治疗3个月,后行宫腔镜检查了解术后宫腔情况,并以此为最终结论。观察组于术后第一次月经干净第3~7天行二次宫腔探查,对照组未行宫腔镜二次探查。对比两组临床价值。结果治疗前,两组患者子宫内膜增长及月经量水平对比差异无统计学意义(P>0.05);治疗后观察组子宫内膜及月经量明显高于(多于)对照组,差异有统计学意义(P<0.05);统计两组术后3个月后宫腔再粘连发生率得出观察组明显低于对照组,差异有统计学意义(P<0.05)。结论为中重度宫腔粘连行宫腔粘连分解术后二次宫腔镜探查,有助于了解患者宫腔恢复情况,及时采取相应措施处理,从根源上预防宫腔再粘连,值得在临床推广应用。

Objective To explore the clinical value of secondary exploration after hysteroscopic operation in patients with moderate to severe intrauterine adhesions. Methods 50 patients with moderate to severe intrauterine adhesions who were admitted to our hospital from January 2015 to January 2017 were selected as research objects. After admission and diagnosis,all patients underwent hysteroscopic intrauterine adhesion decomposition (TCRA). According to the random number table method,they were divided into control group and observation group,with 25 cases in each group.After 3 months of continuous artificial treatment,hysteroscopy was performed to understand the postoperative conditions of uterine cavity in the two groups,and this was the final conclusion.The observation group was given a secondary hysteroscopic exploration on the third to seventh day after the first menstrual cleanup,while the control group was not given a secondary hysteroscopic exploration.The clinical values of the two groups were compared. Results Before treatment,there was no statistically significant difference in endometrial growth and menstrual volume between the two groups (P > 0.05).After treatment,endometrium and menstrual volume in the observation group were significantly higher than/morer than those in the control group,and the difference was statistically significant (P < 0.05). The incidence of uterine re-adhesion in 3 months after surgery in the observation group was statistically lower than that in the control group (P < 0.05). Conclusion The secondary hysteroscopic exploration after intrauterine adhesion decomposition for patients with moderate to severe intrauterine adhesions helps to understand the patient’s uterine recovery.Taking timely measures to prevent intrauterine adhesions from the root is worthy of clinical application.