TCRA术后Foley球囊+自交联透明质酸钠凝胶在宫腔粘连患者中的应用效果
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摘要
目的探讨宫腔粘连患者宫腔镜下宫腔粘连分离术(transcervical resection of adhesions,TCRA)术后应用Foley球囊+自交联透明质酸钠凝胶预防术后再粘连的临床效果。方法选取我院在2015年12月至2017年11月收治的中重度宫腔粘连患者120例,按照随机数字表法分为观察组和对照组,每组各60例;观察组在TCRA术后应用Foley球囊+自交联透明质酸钠凝胶预防再粘连;对照组在TCRA术后应用Foley球囊+普通医用透明质酸钠凝胶预防再粘连。术后3个月观察两组患者临床疗效及AFS评分、粘连范围、粘连类型、月经状况及再粘连状况。结果治疗后观察组临床有效率为86.67%(52/60),对照组临床有效率为71.67%(43/60),比较具有统计学差异(χ2=4.093,P<0.05);术后3个月宫腔镜检查两组患者AFS总分、粘连范围评分、粘连类型及月经状况评分较术前均明显下降(P<0.05);观察组AFS总分、月经状况评分明显低于对照组,差异具有统计学意义(P<0.05);两组患者术后粘连范围、粘连类型比较差异无统计学意义(P>0.05);术后3个月宫腔镜检查,观察组术后再粘连发生率为1.92%(1/52),对照组术后再粘连发生率为16.28%(7/43),比较具有统计学差异(χ2=4.566,P<0.05)。结论宫腔粘连患者TCRA术后应用Foley球囊+自交联透明质酸钠凝胶预防粘连效果显著,能够有效降低AFS评分及月经状况,值得临床推广。
Objective To investigate the clinical effect of Foley balloon + self-crosslinked sodium hyaluronate gel for preventing postoperative adhesions after TCRA in patients with intrauterine adhesions. Methods A total of 120 patients with moderate-severe intrauterine adhesions were selected from December,2015 to November,2017 in our hospital. According to the random number table,the patients were divided into the observation group and the control group,with 60 cases in each. The observation group was treated with TCRA Foley balloon + self-crosslinked sodium hyaluronate gel to prevent re-adhesion,and the control group was treated with TCRA Foley balloon + ordinary medical sodium hyaluronate gel to prevent re-adhesion. The clinical efficacy and AFS scores were observed. Results The total AFS score,adhesion area score,adhesion type and menstrual status score of the two groups were significantly decreased(P < 0. 05) 3 months after the hysteroscopy; and the AFS score and the menstrual status score of the observation group were significantly lower than that of the control group(P < 0. 05). After treatment,the clinical effective rate was 86. 67%(52/60) in the observation group and 71. 67%(43/60) in the control group with statistical significance(χ2= 4. 093,P < 0. 05). The incidence of re-adhesion was 1. 92%(1/52) in the observation group and 16. 28%(7/43) in the control group3 months after hysteroscopy. There was a statistically significant difference between the two group(χ2= 4. 566,P < 0. 05). Conclusion The application of Foley balloon + self-crosslinked sodium hyaluronate gel to prevent adhesion in patients with intrauterine adhesions after TCRA is effective in reducing the AFS score and menstrual status,which is worthy of clinical promotion.
Objective To investigate the clinical effect of Foley balloon + self-crosslinked sodium hyaluronate gel for preventing postoperative adhesions after TCRA in patients with intrauterine adhesions. Methods A total of 120 patients with moderate-severe intrauterine adhesions were selected from December,2015 to November,2017 in our hospital. According to the random number table,the patients were divided into the observation group and the control group,with 60 cases in each. The observation group was treated with TCRA Foley balloon + self-crosslinked sodium hyaluronate gel to prevent re-adhesion,and the control group was treated with TCRA Foley balloon + ordinary medical sodium hyaluronate gel to prevent re-adhesion. The clinical efficacy and AFS scores were observed. Results The total AFS score,adhesion area score,adhesion type and menstrual status score of the two groups were significantly decreased(P < 0. 05) 3 months after the hysteroscopy; and the AFS score and the menstrual status score of the observation group were significantly lower than that of the control group(P < 0. 05). After treatment,the clinical effective rate was 86. 67%(52/60) in the observation group and 71. 67%(43/60) in the control group with statistical significance(χ2= 4. 093,P < 0. 05). The incidence of re-adhesion was 1. 92%(1/52) in the observation group and 16. 28%(7/43) in the control group3 months after hysteroscopy. There was a statistically significant difference between the two group(χ2= 4. 566,P < 0. 05). Conclusion The application of Foley balloon + self-crosslinked sodium hyaluronate gel to prevent adhesion in patients with intrauterine adhesions after TCRA is effective in reducing the AFS score and menstrual status,which is worthy of clinical promotion.
引文
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[14]王明凯,王蔼明,尹善德,等.水囊联合不同剂量雌激素用于宫腔粘连辅助治疗的疗效观察[J].解放军医学院学报,2014,35(7):667-700.
[15]吴丽芳,张甦,万择秋,等.中重度宫腔粘连分离术后影响妊娠率的多因素分析[J].中国妇幼保健,2015,30(35):6397-6399.
[16]Mazzon I,Favilli A,Cocco P,et al.Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions?A retrospective study[J].Fertil Steril,2014,101(1):294-298.e3.
[17]管媚媚,刘勍,刘畅浩,等.宫腔镜下宫腔粘连分离术后预防再粘连方法比较[J].实用妇产科杂志,2016,32(7):551-553.
[18]Yang JH,Chen MJ,Chen CD,et al.Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries[J].Fertil Steril,2013,99(7):2092-2096.e3.
[19]陈灿明,王奕芳,顾小燕,等.宫腔粘连病因学及治疗研究进展[J].国际妇产科学杂志,2016,43(3):250-253.
[20]林丽,文丽,谢娟华,等.雌激素联合安宫黄体酮片在宫腔镜手术治疗宫腔粘连中的应用效果[J].实用临床医学,2017,18(6):63-64.
[2]姚秀华,刘剀,都红蕾,等.放置防粘连膜或注水球囊预防重度宫腔粘连术后复发疗效研究[J].中国实用妇科与产科杂志,2016,32(6):541-544.
[3]Lee J,Lee S,Jung Y,et al.Use of an absorbable adhesion barrier for reconstruction of partial mastectomy defects in the upper quadrant of large ptotic breasts[J].Surg Oncol,2015,24(2):123-127.
[4]Hooker A,Fraenk D,Brolmann H,et al.Prevalence of intrauterine adhesions after termination of pregnancy:a systematic review[J].Eur J Contracept Reprod Health Care,2016,21(4):329-335.
[5]Hooker AB,de Leeuw R,van de Ven PM,et al.Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage:short-term outcomes of a multicenter,prospective randomized controlled trial[J].Fertil Steril,2017,107(5):1223-1231.e3.
[6]Yang JH,Chen CD,Chen SU,et al.The influence of the location and extent of intrauterine adhesions on recurrence after hysteroscopic adhesiolysis[J].BJOG,2016,123(4):618-623.
[7]陈坤菊,史小荣,代晓琴.宫腔粘连的预防方法研究进展[J].国际妇产科学杂志,2017,44(5):576-579.
[8]程萍,路静,沙青.宫腔粘连术后预防再粘连的研究现状[J].世界最新医学信息文摘,2017,17(88):27-29.
[9]王亚茹,王淑丽.宫腔粘连治疗的研究进展[J].中国妇幼保健,2015,30(17):2899-2900.
[10]Lin XN,Zhou F,Wei ML,et al.Randomized,controlled trial comparing the efficacy of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis[J].Fertil Steril,2015,104(1):235-240.
[11]Healy MW,Schexnayder B,Connell MT,et al.Intrauterine adhesion prevention after hysteroscopy:a systematic review and metaanalysis[J].Am J Obstet Gynecol,2016,215(3):267-275.e7.doi:10.1016/j.ajog.2016.05.001.
[12]Tsui KH,Lin LT,Cheng JT,et al.Comprehensive treatment for infertile women with severe Asherman syndrome[J].Taiwan J Obstet Gynecol,2014,53(3):372-375.doi:10.1016/j.tjog.2014.04.022.
[13]肖天慧,乐爱文,卓蓉,等.联合应用几丁糖、球囊支架在预防重度宫腔粘连术后再粘连的效果分析[J].重庆医科大学学报,2017,42(4):433-436.
[14]王明凯,王蔼明,尹善德,等.水囊联合不同剂量雌激素用于宫腔粘连辅助治疗的疗效观察[J].解放军医学院学报,2014,35(7):667-700.
[15]吴丽芳,张甦,万择秋,等.中重度宫腔粘连分离术后影响妊娠率的多因素分析[J].中国妇幼保健,2015,30(35):6397-6399.
[16]Mazzon I,Favilli A,Cocco P,et al.Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions?A retrospective study[J].Fertil Steril,2014,101(1):294-298.e3.
[17]管媚媚,刘勍,刘畅浩,等.宫腔镜下宫腔粘连分离术后预防再粘连方法比较[J].实用妇产科杂志,2016,32(7):551-553.
[18]Yang JH,Chen MJ,Chen CD,et al.Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries[J].Fertil Steril,2013,99(7):2092-2096.e3.
[19]陈灿明,王奕芳,顾小燕,等.宫腔粘连病因学及治疗研究进展[J].国际妇产科学杂志,2016,43(3):250-253.
[20]林丽,文丽,谢娟华,等.雌激素联合安宫黄体酮片在宫腔镜手术治疗宫腔粘连中的应用效果[J].实用临床医学,2017,18(6):63-64.