宫腔粘连两种手术方式疗效比较

Clinical observation of effect of mechanical hysteroscopy in intrauterine adhesions

目的比较宫腔镜下冷刀分离手术与电切手术治疗宫腔粘连的临床效果。方法选择2015-01至2016-12在广东省中医院大学城医院妇科诊断为宫腔粘连患者92例,根据术中分离方法的不同,使用微型或硬性剪刀分离的42例为冷刀组,使用电针电环分离的50例为对照组。术后3个月再次行宫腔镜检查,对比两组患者宫腔粘连好转情况、宫腔创面的子宫内膜上皮化过程,月经改善情况并随访妊娠结局。结果冷刀组的完全治愈率高于对照组,分别为(72.9%、56.0%),冷刀组治疗总有效率明显高于对照组,分别为(90.6%、80.0%)。比较两组患者的治愈率、有效率,差异均有统计学意义(P<0.05)。术后3个月再次宫腔镜检查宫腔内膜创面修复程度,冷刀组与电切组内膜上皮化程度比较,不满意者更少,差异有统计学意义。术后3个月月经前复查妇科B超,比较两组患者的子宫内膜厚度,差异有统计学意义(P<0.05)。月经改善情况:两组的月经改善率,差异有统计学意义(P<0.05)。妊娠率:比较两组患者的妊娠率,差异无统计学意义(P>0.05)。结论宫腔粘连使用冷刀治疗可以提高宫腔粘连松解术疗效。

Objective To compare the efficacy and reproductive differences between hysteroscopy(referred to as the cold loop)and energy equipment hysteroscopy(referred to as the electric loop)in the treatment of intrauterine adhesions.Methods The 92 patients who received surgery between January 2015 and December 2016 in the Department of Gynecology of Guangdong Provincial Hospital of TCM were divided into two groups.Cold loop adhesiolysis was performed in 42 patients,while the other 50 patients received electric loop adhesiolysis.Data was collected mainly to compare the fertility results of patients in the first year after operation.These two approaches were adopted to restore the menstrual pattern and the effect and endometrial thickness were observed 3 months after surgery.Results Three months after operation,the total effective rate of the cold loop group was 88.1%and better restoration of the menstrual pattern was achieved than in the electric loop group(76.0%).Endometrial thickness and menstrual rates were improved,and the difference between the two groups was statistically significant.There was,however,no significant difference in fertility outcomes between the two groups within one year after surgery.Conclusions Hysteroscopic adhesiolysis with the cold loop can be used to improve the therapeutic effect after hysteroscopic electric resection.