盆底神经肌肉电刺激对中重度宫腔粘连分离术后预防再粘连的临床研究

Clinical study of pelvic floor neuromuscular electrical stimulation in preventing adhesion after separation of moderate and severe intrauterine adhesions

目的分析盆底神经肌肉电刺激在预防中重度宫腔粘连分离术后再粘连的临床效果。方法选取本院收治的中重度宫腔粘连分离术后患者128例,随机分为对照组和观察组各64例。对照组术后应用宫腔放置透明质酸钠凝胶、宫腔球囊联合大剂量雌激素等综合性治疗,观察组在对照组基础上给予盆底神经肌肉电刺激治疗。观察两组近期疗效、术后月经恢复情况、宫腔镜二次探查中再粘连的发生率及术后6个月妊娠成功率,比较两组子宫内膜厚度和子宫动脉血流阻力指数变化(RI)。结果观察组治疗有效率为93.8%,对照组为81.3%,差异有统计学意义(P<0.05);观察组月经恢复正常率为70.3%,对照组为46.9%,差异有统计学意义(P<0.05);观察组宫腔镜二次探查中再粘连的发生率为17.2%,低于对照组的37.5%(P<0.05);观察组术后6个月妊娠成功率高于对照组(P>0.05);术后6个月观察组子宫内膜厚度和RI值均优于对照组(P<0.05)。结论盆底神经肌肉电刺激在常规治疗基础上降低中重度宫腔粘连分离术后再粘连的发生率,值得临床应用。

Objective To analyze the clinical research of pelvic floor neuromuscular electrical stimulation on preventing adhesion after separation of moderate and severe intrauterine adhesions.Methods A total of 128 patients with moderate to severe intrauterine adhesions were selected from January 2018 to December 2020 in our hospital,and they were randomly divided into control group and experimental group,with 64 cases in each group.The control group was treated with intrauterine injection of sodium hyaluronate gel,intrauterine balloon combined with high-dose estrogen.The experimental group was treated with pelvic floor neuromuscular stimulation on the basis of the control group.The short-term efficacy,postoperative menstrual recovery,the incidence of re-adhesion in the second exploration of hysteroscopy and the success rate of pregnancy at six months after operation were observed.The endometrial thickness and uterine artery resistance index(RI)were compared between the two groups.Results The effective rate of the experimental group was 93.8%,and that of the control group was 81.3%,P<0.05;the menstrual recovery rate of the experimental group was 70.3%,and that of the control group was 46.9%,P〈0.05;the incidence of re-adhesion in the second exploration of hysteroscopy in the experimental group was 17.2%,which was lower than 37.5% of the control group,P<0.05;the pregnancy success rate of the two groups at six months after operation was not statistically significant,P>0.05;the observation was conducted after six months,and endometrial thickness and RI value of experimental group were better than those of control group,P<0.05.Conclusion On the basis of conventional treatment,pelvic floor neuromuscular electrical stimulation can reduce the incidence of re-aclhesion after separation of moderate and severe intrauterine adhesions,which is worthy of clinical application.