宫腔粘连分离术后不同抗粘连法的临床疗效

Clinical curative effects of different anti-adhesion methods after hysteroscopic adhesiolysis

目的探讨宫腔粘连分离术后不同抗粘连法的临床疗效。方法选取2015年1月-2017年12月乐清市人民医院收治的210例宫腔粘连患者为研究对象,随机分为激素组(术后给予戊酸雌二醇片治疗)、宫内节育组(术后宫腔内放置宫内节育器)、联合组(戊酸雌二醇片联合宫内节育器),每组70例。比较3组临床疗效、治疗前后美国生育学会(AFS)评分、子宫内膜厚度及宫腔容积、再粘连发生率和不良反应发生率。结果联合组总有效率明显高于激素组、宫内节育组(均P<0.05),但激素组与宫内节育组比较差异无统计学意义(P>0.05)。治疗前3组粘连范围、粘连类型、月经状况评分、子宫内膜厚度、宫腔容积比较差异无统计学意义(P>0.05);治疗后,联合组粘连范围、粘连类型、月经状况评分低于激素组和宫内节育组(均P<0.05),激素组与宫内节育组比较差异均无统计学意义(均P>0.05);联合组子宫内膜厚度、宫腔容积高于激素组和宫内节育组(均P<0.05),激素组与宫内节育组比较差异均无统计学意义(均P>0.05)。联合组再粘连率低于宫内节育组和激素组(均P<0.05)。3组患者胃肠不适、乳腺囊性结节增大、不良反应总发生率比较差异均无统计学意义(均P>0.05)。结论宫腔粘连分离术后联合激素类药物结合宫内节育器治疗可有效提高疗效,改善粘连程度、子宫内膜和宫腔容积,有效降低再粘连率,安全性高。

Objective To explore the clinical curative effects of different anti-adhesion methods after hysteroscopic adhesiolysis.Methods From January 2015 to December 2017,210 patients with intrauterine adhesion treated in Yueqing People’s Hospital were selected and randomly divided into hormone group(estradiol valerate after surgery),intrauterine device group(intrauterine placement of intrauterine device),and combination group(estradiol valerate combined with intrauterine placement of intrauterine device),70 patients in each group.The clinical curative effects,AFS scores,endometrial thicknesses,uterine cavity volumes,the incidence rates of readhesion,and the incidence rates of adverse reactions in the three groups were compared.Results The total effective rate in combination group was statistically significantly higher than those in hormone group and intrauterine device group(P<0.05),there was no statistically significant difference between hormone group and intrauterine device group(P>0.05).Before treatment,there was no statistically significant difference in adhesion range,type,menstrual score,endometrial thickness,intrauterine volume among the three groups(P>0.05).After treatment,adhesion range,type,menstrual score in combination group were statistically significantly lower than those in hormone group and intrauterine device group(P<0.05),there was no statistically significant difference between hormone group and intrauterine device group(P>0.05).Endometrial thickness and intrauterine volume in combination group were statistically significantly higher than those in hormone group and intrauterine device group(P<0.05),there was no statistically significant difference between hormone group and intrauterine device group(P>0.05).The rate of readhesion in combination group was statistically significantly lower than those in hormone group and intrauterine device group(P<0.05).There was no statistically significant difference in upset stomach,increase of breast cystic nodules,the total incidence rate of adverse reactions among the three groups(P>0.05).Conclusion Hormone combined with intrauterine device after hysteroscopic adhesiolysis can effectively improve curative effect and adhesion degree,endometrium and uterine volume,effectively reduce the rate of readhesion,the safety is high.