宫腔内尿管留置辅助宫腔镜下宫腔粘连分离术治疗宫腔粘连临床效果观察

Clinical effect of intrauterine catheter indwelling assisted Transcervical resection of adhesions of intrauterine adhesions

目的观察宫腔内尿管留置辅助宫腔镜下宫腔粘连分离术(TCRA)治疗宫腔粘连的临床效果。方法回顾性分析川北医学院附属医院自2017年1月至2020年1月收治的133例宫腔粘连患者的临床资料。根据治疗方案不同,将接受TCRA+宫内留置节育环治疗的70例患者纳入A组,将接受TCRA+宫腔内尿管留置治疗的63例患者纳入B组。比较两组患者的治疗有效率,治疗前后的宫腔粘连评分、月经状态评分,以及复发率、妊娠率。结果A组治愈28例、有效26例、无效16例,有效率为77.14%(54/70);B组治愈35例、有效24例、无效4例,有效率为93.65%(54/63)。两组患者治疗有效率比较,差异有统计学意义(P<0.05)。A组和B组治疗前宫腔粘连评分分别为(22.13±4.20)分和(22.69±4.42)分,差异无统计学意义(P>0.05);治疗后1周分别为(17.30±3.35)分和(13.45±3.49)分,均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。A组和B组治疗前月经状态评分分别为(1.89±0.56)分和(1.93±0.60)分,差异无统计学意义(P>0.05);治疗后1周分别为(1.10±0.35)分和(0.56±0.18)分,均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。A组和B组治疗后3个月的复发率分别为30.00%(21/70)和22.22%(14/63),差异无统计学意义(P>0.05);治疗后6个月的复发率分别为42.86%(30/70)和25.40%(16/63),差异有统计学意义(P<0.05)。A组和B组妊娠率分别为7.14%(5/70)和11.11%(7/63),差异无统计学意义(P>0.05)。结论宫腔内尿管留置辅助TCRA治疗宫腔粘连可有效缓解患者的临床症状,减轻宫腔粘连程度,促进月经恢复,降低复发风险。

Objective To investigate the effect of intrauterine catheter indwelling assisted with Transcervical resection of adhesions(TCRA)of intrauterine adhesions.Methods Clinical data of 133 patients with intrauterine adhesions were retrospectively analyzed in the period from January 2017 to January 2020.According to different treatment plans,70 patients receiving TCRA+intrauterine contraceptive ring were included in Group A,and 63 patients receiving TCRA+intrauterine catheter indwelling were included in Group B.The total effective rate,intrauterine adhesions score and menstrual state score before and after treatment,recurrence rate and pregnancy rate with follow-up were compared between the two groups.Results In Group A,28 cases were cured,26 cases were effective and 16 cases were ineffective,and the effective rate was 77.14%(54/70);in Group B,35 cases were cured,24 cases were effective,4 cases were ineffective,and the effective rate was 93.65%(54/63).There was statistical significance in the effective rate between the two groups(P<0.05).Before treatment,the intrauterine adhesion scores of Group A and Group B were(22.13±4.20)and(22.69±4.42)points,respectively,with no statistical significance(P>0.05);1 week after treatment,the scores were(17.30±3.35)and(13.45±3.49),respectively,lower than those before treatment,and Group B was lower than Group A(P<0.05).The menstrual status scores of Group A and Group B before treatment were(1.89±0.56)and(1.93±0.60),respectively,and the difference was not statistically significant(P>0.05);1 week after treatment,they were(1.10±0.35)and(0.56±0.18)points,respectively,lower than those before treatment,and Group B was lower than Group A(P<0.05).The recurrence rates of Group A and Group B at 3 months after treatment were 30.00%(21/70)and 22.22%(14/63),respectively,and the difference was not statistically significant(P>0.05).The recurrence rates at 6 months after treatment were 42.86%(30/70)and 25.40%(16/63),respectively(P<0.05).The pregnancy rates of Group A and Group B were 7.14%(5/70)and 11.11%(7/63),respectively,and the difference was not statistically significant(P>0.05).Conclusion Intrauterine catheter indwelling assisted with TCRA in the treatment of intrauterine adhesions can effectively relieve clinical symptoms,reduce the degree of intrauterine adhesions,promote menstrual recovery process and be helpful to reduce the recurrence risk.