双极汽化与微型剪刀对中重度宫腔粘连分离术的疗效影响

Effect of bipolar vaporization and micro scissors on the separation of moderate and severe intrauterine adhesions

目的探讨双极汽化与微型剪治疗中重度宫腔粘连的临床效果。方法选择2020年1~6月在我院宫腔镜下行宫腔粘连分离术治疗的患者101例,将患者分为微型剪刀治疗组52例,双极汽化治疗组49例。所有患者在宫腔镜下实施宫腔粘连分离术后3个月再行第二次宫腔镜手术。观察比较两组患者两次宫腔镜手术时间、手术出血量、美国生育协会(American Fertility Association,AFS)评分,宫腔形态情况以及月经恢复情况。结果两组患者行宫腔粘连分离术后的宫腔形态治愈率及第二次宫腔镜手术时间、AFS评分方面比较,汽化组各指标改善均优于微型剪组,差异均有统计学意义(均P<0.05);而两组患者宫腔形态恢复有效率、月经恢复情况、第一次宫腔镜手术时间、两次宫腔镜手术出血量等方面比较,差异均无统计学意义(均P>0.05)。结论双极汽化治疗中重度宫腔粘连的宫腔形态治愈率较微型剪高,但两者宫腔形态恢复有效率、安全性相当。治疗上应根据患者情况,选择个体化治疗方案。

Objective To investigate the clinical effect of bipolar vaporization and micro scissors in moderate and severe intrauterine adhesion.Methods A retrospective analysis of 101 patients with moderate and severe intrauterine adhesion who underwent hysteroscopic separation of intrauterine adhesions in our hospital from January 2020 to June 2020.They were divided into bipolar vaporization treatment group(49 cases)and micro scissors treatment group(52 cases).All patients underwent a second hysteroscopy 3 months after hysteroscopic separation of uterine adhesions.The menstruation and uterine cavity recovery were observed.Results There were no significant differences between the two groups in general condition,the time of the first hysteroscopic operation,the amount of intraoperative bleeding,the score of American Fertility Association(AFS),postoperative menstrual recovery and the effective rate of uterine morphology recovery(P>0.05 for each).There were significant differences in the time of the second hysteroscopic operation,the decrease of AFS score and the recovery of uterine cavity morphology between the two groups(P<0.05 for each).Conclusion The cure rate of intrauterine morphology in the treatment of moderate and severe intrauterine adhesion by bipolar vaporization is higher than that by micro shear,but they have the same efficiency and safety.During operation,appropriate instruments should be selected according to the specific conditions during operation,and individualized treatment scheme should be advocated.