重度宫腔粘连分离术后预防再粘连方法的比较

论著

重度宫腔粘连分离术后预防再粘连方法的比较

申爱荣 刘琼丽

摘要 目的 评估宫腔镜宫腔粘连分离术后预防宫腔再粘连方法的疗效。方法 回顾性分析2004年11

月至2007年5月间郑州大学第三附属医院妇科内镜诊治中心122例宫腔镜下宫腔粘连切除术患者的临床资料。术后宫腔内放置节育环(IU D )58例为I U D 组,宫腔注入几丁糖并IU D 64例为IU D+几丁糖组;根据病程长短将IU D 组分为Ia 组(病程 1年)和Ib 组(病程>1年),IU D+几丁糖组分为IIa 组(病程 1年)和IIb 组(病程>1年)。观察术后宫腔恢复情况、月经改善及妊娠情况。结果 IU D 和IU D+几丁糖组术后宫腔再粘连率分别为41 4%和23 4%(P <0 05),其中Ia 组(19 0%)明显低于Ib 组(54 1%)(P <0 05);IU D 组月经改善率及妊娠率分别为74 1%和29 3%,I U D+几丁糖组分别为92 2%和48 4%,IU D 组明显低于IU D+几丁糖组(P <0 05),其中Ia 组(90 0%、47 6%)明显高于Ib 组(64 9%、18 9%)(P <0 05)。I Ia 组术后宫腔再粘连率及妊娠率分别为8 7%和78 3%,IIb 组分别为31 7%和31 7%,两组比较,差异均有统计学意义(P <0 05);IIa 组(100%)月经改善率与IIb 组(87 8%)比较,差异无统计学意义(P >0 05)。结论 重度宫腔粘连切除术后宫腔内放置节育环加几丁糖可有效预防再粘连,提高月经改善率及妊娠率。

关键词

宫腔镜;宫腔粘连;宫腔粘连分离术;再粘连

Comparative study on methods of preventing adhesion recurrence after transcervical resection of intrauterine adhesions

S H EN A ir ong ,L I U Qiongli.

(D ep ar tment of O bs tetr ics and Gy necology ,the T hir d A f f iliated H osp ital ,Zhengz hou Univer sity ,

H enan 450052,China)

Abstract Objective T o appr aise t he effect of the tw o methods pr eventing adhesio n recurrence after trans -cervical resectio n o f intrauterine adhesions.Methods Clinical dat a o f 122patients wit h severe intr auter ine adhe -sions who under went transcerv ical r esectio n during No vember 2004to M a y 2007in g ynecolog ic endoscopy cent er of the third affiliated ho spital of Zheng Zhou U niversit y w ere studied retro spectiv ely.Patients w ere divided into tw o g roups acco rding to the different ther apy metho ds.58patients w ho w ere placed w ith IU D po stoperation w ere in g roup ,64patients infused w ith M edica l Chito san and placed IU D composed g roup ;then patients w ere div ided into g r oup Ia,I Ia (the course of disease o ne year )and gr oup b, b (the course of disease>one y ear).T he r e -store o f intrauter ine cav ity,impro vement o f menses and r ate o f preg nancy w ere studied.Results T he adhesions r e -cur rence r ate was 41 4%in g ro up and 23 4%in g roup (P <0 05),and it w as sig nificant lo wer in Ia g r oup compared to Ib g roup (19 0%vs 54 1%,P <0 05).T he impr ov ing r ate of menses and conception wer e 74 1%,29 3%in gr oup I and 92 2%,48 4%in g ro up II (P <0 05);these rates in gr oup Ia w ere 90 0%and 47 6%w hich w ere signifi cant hig her (P <0 05)than that in group Ib (64 9%,18 9%).While there wer e no significant difference for t hese rates in a and b g roup (P <0 05).Conclusions Infusing M edical Chito san follow ed IU D after tr anscerv ical r esectio n is an effectiv e method in prev enting adhesion recurrence,also it can incr ease the menses impro ving rate and co nception r ate.T he short er the cour se of disease,the low er the adhesions recur rence r ate,and the higher the concept ion rate.

Key words hystero sco py ;sev ere intr auter ine adhesions;synechio ly sis;adhesion recurr ence Chin J Clin O bst et Gynecol,2010,11:25-27

doi:10 3969/j issn 1672-1861 2010 01 008

本课题受河南省卫生厅科技攻关项目200804032资助

作者单位:450052 郑州大学第三附属医院妇科内镜诊治中心

宫腔粘连(intr auter ine adhesions,IU A )主

要由创伤和感染引起,临床上表现为闭经或月经量减少、周期性腹痛、继发不孕与妊娠异常。宫腔镜宫腔粘连切除术(transcerv ical r esectio n of adhe -