子宫球囊支架术后宫腔镜二探预防宫腔粘连复发的临床疗效

Clinical Effect of Hysteroscopy on the Relapse of Uterine Adhesion after Uterine Spherical Capsular Support

目的:探讨子宫球囊支架术后宫腔镜二次探查预防宫腔粘(intrauterineadhesions,IUA)复发的临床疗效。方法:选取2015年6月-2019年12月本院收治的IUA患者56例,按照随机数字表法分为两组,每组各28例。研究组接受宫腔镜下宫腔粘连分解(transcervical resection of adhesions,TCRA)术+COOK球囊子宫支架放置术+雌孕激素人工周期,雌孕激素干预1周期时接受宫腔镜探查,再行雌孕激素干预2周期,必要时实施宫腔镜探查;对照组行TCRA术+COOK球囊子宫支架放置术+雌孕激素人工周期,仅在术后3周期雌孕激素的干预,必要时接受宫腔镜探查。针对两组IUA的复发情况进行观察及对比。结果:研究组月经好转率高于对照组(P<0.05),研究组IUA复发总数低于对照组(P<0.05),研究组月经过少及闭经比率低于对照组(P<0.05),研究组治疗后3个月的子宫内膜厚度高于对照组(P<0.05)。结论:宫腔粘连患者实施TCRA术+COOK球囊子宫支架放置术+雌孕激素治疗后的复发风险较高,而给予患者实施TCRA术+COOK球囊子宫支架放置术+雌孕激素人工周期,术后及时实施二次宫腔镜探查,能准确直观了解宫腔形态的恢复,及时钝性分离新生粘连,可有效地降低患者IUA的复发率,促进子宫内膜再生修复,改善患者的月经情况。

Objective:To investigae the clinical efficacy of hysteroscopic secondary exploration in the prevention of recurrence of intrauterine adhesion(intrauterineadhesions,IUA)after uterine balloon stenting.Method:From June 2015 to December 2019,56 IUA patients in our hospital were selected,they were divided into two groups,28 cases in each group.The study group underwent hysteroscopic intrauterine adhesion decomposition(transcervical resection of adhesions,TCRA)COOK balloon uterine stent placement during the artificial cycle of estrogen and progesterone,and hysteroscopy during the 1 cycle of estrogen intervention probing,followed by estrogen intervention for 2 cycles,and hysteroscopy if necessary;control group performed TCRA surgery COOK balloon uterine stent placement for the artificial cycle of estrogen and progesterone,only after 3 cycles of estrogen intervention,if necessary,hysteroscopy exploration.According to the recurrence of IUA in the two groups were observed and compared.Result:The rate of good menstrual cycle in the study group was higher than that in the control group(P<0.05),the total IUA recurrence in the study group was lower than that in the control group(P<0.05),the menstrual cycle was less and the amenorrhea ratio was lower than that in the control group group(P<0.05).Conclusion:Patients with intrauterine adhesions have a higher risk of recurrence after TCRA COOK balloon stenting,estrogen and progestin therapy,while patients with intrauterine adhesions are given a second hysteroscopic exploration,which can accurately and intuitively understand the recovery of uterine cavity morphology,blunt separation of new adhesions,can effectively reduce the recurrence rate of IUA,promote endometrial regeneration and repair,and improve menstrual conditions.