HEOS宫腔镜下微型剪刀分离术与宫腔镜电切分离术治疗重度宫腔粘连患者的疗效比较

Effect Comparisons of HEOS-guided Micro-scissor Separation and Hysteroscopic Electrotomy on the Treatment of Severe Intrauterine Adhesion

目的对重度宫腔粘连(IUA)经HEOS宫腔镜下微型剪刀分离术、宫腔镜电切分离术治疗的临床效果予以分析。方法对商丘市第五人民医院2020年1月至2022年12月收录的86例重度IUA患者进行研究,应用随机抽样法划分为HEOS组、对照组,各43例,分别给予HEOS宫腔镜下微型剪刀分离术、宫腔镜电切分离术,比较围手术期指标(手术时间、术中膨宫液吸收量和失血量)、临床疗效、血清基质金属蛋白酶-9(MMP-9)、转化生长因子-β1(TGF-β1)及术后复发率、月经改善率、患者生活质量综合评分(GQOLI-74)。结果经比较HEOS组术中膨宫液吸收量、手术失血量少于对照组,手术时间HEOS组短于对照组;HEOS组(95.35%)有效率高于对照组(79.07%),差异有统计学意义(P<0.05)。术前两组MMP-9、TGF-β1水平比较,差异无统计学意义(P>0.05);术后HEOS组MMP-9高于对照组,TGF-β1低于对照组,差异有统计学意义(P<0.05)。术后1个月、3个月HEOS组复发率低于对照组,月经月经改善率高于对照组,差异有统计学意义(P<0.05)。术前两组GQOLI-74评分比较,差异无统计学意义(P>0.05);术后HEOS组GQOLI-74评分高于对照组,差异有统计学意义(P<0.05)。结论HEOS宫腔镜下微型剪刀分离术临床疗效显著,手术时间短于宫腔镜电切分离术,且患者出血量和膨宫液吸收量少,月经恢复率高,MMP-9水平升高,TGF-β1水平降低,并且降低了复发率,提高了生活质量。

Objective Analyze the clinical effects of treating severe intrauterine adhesions(IUA)through HEOS hysteroscopic microsurgical separation and hysteroscopic resection separation.Methods A total of 86 patients with severe IUA enrolled in the Fifth People's Hospital of Shangqiu City from January 2020 to December 2022 were studied and divided into HEOS group and control group by random sampling method,with 43 cases in each group The patients were treated with HEOS hysteroscopic mini scissors separation and hysteroscopic electrosurgical separation,and the perioperative indicators(Surgical time,intraoperative absorption of uterine distension fluid,and blood loss),clinical efficacy,serum matrix metalloproteinase-9(MMP-9),and Transforming growth factor were compared-β1(TGF-β1)And postoperative recurrence rate,menstrual improvement rate,and generic quality of Life Inventory-74(GQOLI-74).Results The amount of dilatory fluid absorption and blood loss during operation in HEOS group was less than that in control group,and the operation time in HEOS group was shorter than that in control group.The effective rate of HEOS group(95.35%)was higher than that of control group(79.07%),and the difference was statistically significant(P<0.05).Compared with MMP-9 and TGF-βAt level 1,there was no statistically significant difference between the two groups before surgery(P>0.05).Compared after surgery,MMP-9 in the HEOS group was higher than that in the control group,with TGF-β1 is lower than the control group,and the difference is statistically significant(P<0.05);The recurrence rate of HEOS group 1 month and 3 months after operation was lower than that of control group,and the menses improvement rate was higher than that of control group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the preoperative GQOLI-74 score(P>0.05),but the postoperative comparison showed that the HEOS group was higher than the control group,the difference was statistically significant(P<0.05).Conclusion The clinical efficacy of HEOS hysteroscopic microsurgical separation is significant.Compared:with hysteroscopic electrosurgical separation,the surgical time is shorter,the amount of bleeding and absorption of uterine fluid is less,and higher menstrual recovery rate.MMP-9 levels were increased,TGF-β1 levels were decreased,the recurrence rate has been reduced,and thus the quality of life has been improved.