宫腔镜下两种手术方式治疗宫腔粘连的效果观察

Comparison of hysteroscopic plasma resection and hysteroscopic cold knife micro-shearing in treatment of intrauterine adhesions

目的 观察宫腔镜等离子电切治疗和宫腔镜冷刀微剪治疗这两种手术方式对宫腔粘连的疗效。方法 选取2020年1月1日至6月30日嘉兴市妇幼保健院收治的行宫腔镜手术治疗的宫腔粘连患者132例。其中66例采用宫腔镜等离子电切治疗,为宫腔镜等离子电切组;另66例采用宫腔镜冷刀微剪治疗,为宫腔镜冷刀微剪组。于术后3个月再次对患者行宫腔镜探查,术后6个月电话随访患者月经及妊娠状态。观察并比较两组患者临床疗效、子宫容受性相关指标、月经改善情况与妊娠情况。结果 两组患者治疗3个月后宫腔粘连复发率比较差异无统计学意义(27.27%比24.24%,P>0.05),子宫内膜厚度、宫腔容积均大于术前(均P<0.05);但两组患者术后子宫内膜厚度、宫腔容积比较差异均无统计学意义[(1.04±0.32)cm比(1.07±0.33)cm、(6.64±1.19)ml比(6.67±1.21)ml,均P>0.05]。术后6个月,宫腔镜冷刀微剪组月经改善率高于宫腔镜等离子电切组(84.85%比68.18%,P<0.05),而两组患者妊娠率比较差异无统计学意义(39.39%比43.93%,P>0.05)。结论宫腔镜等离子电切治疗与宫腔镜冷刀微剪治疗宫腔粘连均操作安全、疗效可靠,可改善患者的子宫容受性,选择宫腔镜冷刀微剪在术后可能有更好的月经改善率。

Objective To compare the efficacy of hysteroscopic plasma resection and hysteroscopic cold knife microscissors in treatment of intrauterine adhesion.Methods A total of 132 patients with intrauterine adhesion admitted in Jiaxing Maternal and Child Health Hospital from January 2020 to June 2020 were enrolled.Among them,66 cases were treated with hysteroscopic plasma resection,and other 66 cases were treated with hysteroscopic cold knife micro-shearing.The followup hysteroscopy was performed 3 months after the operation,and the menstruation and pregnancy status of the patient were followed up by telephone 6 months after the operation.The clinical efficacy,uterine receptivity,menstrual improvement and pregnancy were observed and compared between the two groups.Results There was no significant difference in the recurrence rate of intrauterine adhesion between two groups after 3 months of treatment(27.27%vs.24.24%,P>0.05).After the operation,the endometrial thickness and uterine cavity volume of the two groups were greater than those before the operation(both P<0.05);there was no significant difference in endometrial thickness and uterine cavity volume between the two groups(1.04±0.32 cm vs.1.07±0.33 cm,6.64±1.19 ml vs.6.67±1.21 ml,P>0.05).Six months after operation,the menstrual improvement rate of the hysteroscopic cold knife micro-shearing group was higher than that of the hysteroscopic plasma resection group(84.85%vs.68.18%,P<0.05),and there was no significant difference in pregnancy rate between the two groups(39.39%vs.43.93%,P>0.05).Conclusion Both hysteroscopic plasma resection and hysteroscopic cold knife micro-shearing are safe and effective in the treatment of intrauterine adhesion,while hysteroscopic cold knife micro-shearing may better improve the menstruation of patients.