不同宫腔屏障对复发性重度宫腔粘连患者行宫腔镜下分离术预后的影响

Effect of different uterine barrier on the prognosis of patients with recurrent intrauterine adhesions after hysteroscopic adhesiolysis

目的分析不同宫腔屏障对复发性重度宫腔粘连患者行宫腔镜下分离术预后的影响。方法选取2017年1月至2018年12月贵阳市第四人民医院接诊的176例拟行宫腔镜下宫腔粘连分离术的复发性重度宫腔粘连患者作为研究对象。随机分为A组(n=88)和B组(n=88)。A组患者置入Foley球囊导尿管结合注入医用自交联透明质酸钠凝胶,B组患者单纯置入Foley球囊导尿管。随访3个月,在术前1d及术后3个月进行美国生育协会(AFS)评分、三维超声检查,综合评价临床疗效,比较两组患者中重度宫腔再粘连率、宫腔镜下宫腔形态完全恢复正常率。结果两组患者均顺利完成手术,获得随访,其中A组患者术后3个月AFS评分及粘连范围、粘连类型、月经模式评分均低于B组,子宫内膜厚度、宫腔容积、子宫内膜下血流指数均高于B组,差异均具有统计学意义(均P<0.05);A组患者临床总有效率高于B组,差异具有统计学意义(P<0.05);A组患者术后3个月中重度宫腔再粘连率、宫腔镜下宫腔形态完全恢复正常率明显高于B组,差异具有统计学意义(P<0.05)。结论以置入Foley球囊导尿管结合注入医用自交联透明质酸钠凝胶作为宫腔屏障,能明显减轻宫腔镜下复发性重度宫腔粘连分离术后再粘连程度、预防复发和改善预后,且安全性尚可,临床效果较好。

Objective To analyze the effect of different uterine barriers on the prognosis of patients with recurrent intrauterine adhesions after hysteroscopic adhesiolysis.Methods 176 patients with recurrent intrauterine adhesions in Fourth People's Hospital of Guiyang City from January 2017 to December 2018 were selected and were randomly divided into group A and group B,88 cases each.Group A was placed in Foley balloon catheter combined with medical self-crosslinking sodium hyaluronate gel,and group B was placed into Foley balloon catheter.All the patients were followed up for 3 months and American Fertility Association(AFS)score and three-dimensional ultrasound examination were performed 1 day before surgery and 3 months after surgery,for comprehensive evaluation of clinical efficacy and comparing the rate of severe intrauterine readhesion in the two groups and the recovery of hysteroscopic u-terine morphology.Results All the patients successfully completed the operation and were followed up.The AFS score,adhesion range,adhesion type and menstrual pattern score of group A were significantly lower than those of group B and the endometrial thickness,uterine volume and endometrial blood flow index were significantly higher than those in group B,all with statistically significant differences(all P<0.05).The total effective rate of group A was significantly higher than that of group B,with statistically significant differences(P<0.05).The rate of severe uterine re-adhesion in group A was significantly lower than that in group B at 3 months after operation,and the rate of complete recovery of hysteroscopic uterine cavity was significantly higher than that of group B,with statistically significant differences(P<0.05).Conclusions The placement of Foley balloon catheter combined with medical self-crosslinking sodium hyaluronate gel as a uterine barrier,can significantly reduce the degree of re-adhesion after hyste-roscopic adhesiolysis and improve the prognosis with acceptable safety,which is worthy of clinical application.