宫腔粘连分离术后辅助不同方案的治疗效果及术后妊娠

Effect of different adjuvant therapy after seperation of intrauterine adhesion and its influence on the postoperative pregnancy

目的:研究不同辅助治疗方案对宫腔粘连(IUA)患者宫腔粘连分离术(TCRA)术后妊娠的影响。方法:采用随机数字表法将本院2017年1月~2018年1月收治的96例IUA患者均分为3组,TCRA后分别行宫内节育器(IUD)+透明质酸+口服雌孕激素治疗(联合组),IUD+口服雌孕激素治疗(IUD+激素组),透明质酸+口服雌孕激素治疗(透明质酸+激素组),术后随访1年,观察3组治疗效果及妊娠成功率。结果:术后3个月,再粘连发生率联合组最低(9.4%),但3组间无统计学差异(P>0.05);子宫内膜厚度3组均较治疗前增加,且联合组增加最多(P<0.05);治疗有效率联合组最高(93.8%),IUD+激素组最低(71.9%),但3组间无统计学差异(P>0.05);不良反应3组无差异(P>0.05);术后1年妊娠成功率联合组最高(53.1%),但3组间无统计学差异(P>0.05)。结论:TCRA术后辅助节育器+透明质酸+口服雌孕激素能有效防止术后宫腔再粘连,改善患者临床症状,对提高术后1年妊娠率有积极作用,其效果略优于节育器+口服雌孕激素及透明质酸+口服雌孕激素。

Objective:To investigate the influence of different adjuvant therapy for fertility women with intrauterine adhesion(IUA)after transcervical resection of adhesion(TCRA)on the postoperative pregnancy.Methods:96 women with IUA were selected and were divided into groups A,B and C by random number table method from January 2017 to January 2008.The women in group A were treated with intrauterine device(IUD)combined with hyaluronic acid and oral estrogen and progesterone,the women in group B were treated with IUD combined with oral estrogen and progesterone,and the women in group C were treated with oral estrogen and progesterone combined with hyaluronic acid.The women in the three groups were followed up for 1 year,and the treatment effect and pregnancy success rate within 1 year after operation of the women in the three groups were observed.Results:3 months after operation,the incidence of re-adhesion of the women in group A was the lowest(9.4%),but which had no significant different among the three groups(P>0.05).The endometrial thickness of the women in the three groups had increased significantly,and increased most was in group A(P<0.05).The effective rate(93.8%)of the women in group A was the highest,and that(71.9%)of the women in group B was the lowest,but which had no significant different among the three groups(P>0.05).There was no significant difference in adverse reactions of the women among 3 groups(P>0.05).The success rate of pregnancy within one year after operation(53.1%)of the women in group A was the highest,but which had no significant different among the three groups(P>0.05).Conclusion:After TCRA,application of IUD combined with hyaluronic acid and oral estrogen and progesterone can effectively prevent postoperative intrauterine re-adhesion,improve clinical symptoms and success rate of pregnancy within one year after operation,which has better clinical efficacy than that of IUD combined with oral estrogen and progesterone or hyaluronic acid combined with oral estrogen and progesterone.