中重度宫腔粘连患者宫腔镜术后二次探查的临床价值
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摘要
目的探讨中重度宫腔粘连患者宫腔镜术后二次探查的临床价值。方法选取我院2015年1月～2017年1月接收的50例中重度宫腔粘连患者作为此次研究对象,入院确诊后均行宫腔镜下宫腔粘连分解术(TCRA),按照随机数字表法将其分为对照组与观察组,各25例,两组术后人工周期连续治疗3个月,后行宫腔镜检查了解术后宫腔情况,并以此为最终结论。观察组于术后第一次月经干净第3～7天行二次宫腔探查,对照组未行宫腔镜二次探查。对比两组临床价值。结果治疗前,两组患者子宫内膜增长及月经量水平对比差异无统计学意义(P> 0.05);治疗后观察组子宫内膜及月经量明显高于(多于)对照组,差异有统计学意义(P <0.05);统计两组术后3个月后宫腔再粘连发生率得出观察组明显低于对照组,差异有统计学意义(P <0.05)。结论为中重度宫腔粘连行宫腔粘连分解术后二次宫腔镜探查,有助于了解患者宫腔恢复情况,及时采取相应措施处理,从根源上预防宫腔再粘连,值得在临床推广应用。
Objective To explore the clinical value of secondary exploration after hysteroscopic operation in patients with moderate to severe intrauterine adhesions. Methods 50 patients with moderate to severe intrauterine adhesions who were admitted to our hospital from January 2015 to January 2017 were selected as research objects.After admission and diagnosis,all patients underwent hysteroscopic intrauterine adhesion decomposition(TCRA).According to the random number table method,they were divided into control group and observation group,with 25 cases in each group.After 3 months of continuous artificial treatment,hysteroscopy was performed to understand the postoperative conditions of uterine cavity in the two groups,and this was the final conclusion.The observation group was given a secondary hysteroscopic exploration on the third to seventh day after the first menstrual cleanup,while the control group was not given a secondary hysteroscopic exploration.The clinical values of the two groups were compared.Results Before treatment,there was no statistically significant difference in endometrial growth and menstrual volume between the two groups(P > 0.05).After treatment,endometrium and menstrual volume in the observation group were significantly higher than/morer than those in the control group,and the difference was statistically significant(P <0.05).The incidence of uterine re-adhesion in 3 months after surgery in the observation group was statistically lower than that in the control group(P < 0.05). Conclusion The secondary hysteroscopic exploration after intrauterine adhesion decomposition for patients with moderate to severe intrauterine adhesions helps to understand the patient's uterine recovery.Taking timely measures to prevent intrauterine adhesions from the root is worthy of clinical application.
Objective To explore the clinical value of secondary exploration after hysteroscopic operation in patients with moderate to severe intrauterine adhesions. Methods 50 patients with moderate to severe intrauterine adhesions who were admitted to our hospital from January 2015 to January 2017 were selected as research objects.After admission and diagnosis,all patients underwent hysteroscopic intrauterine adhesion decomposition(TCRA).According to the random number table method,they were divided into control group and observation group,with 25 cases in each group.After 3 months of continuous artificial treatment,hysteroscopy was performed to understand the postoperative conditions of uterine cavity in the two groups,and this was the final conclusion.The observation group was given a secondary hysteroscopic exploration on the third to seventh day after the first menstrual cleanup,while the control group was not given a secondary hysteroscopic exploration.The clinical values of the two groups were compared.Results Before treatment,there was no statistically significant difference in endometrial growth and menstrual volume between the two groups(P > 0.05).After treatment,endometrium and menstrual volume in the observation group were significantly higher than/morer than those in the control group,and the difference was statistically significant(P <0.05).The incidence of uterine re-adhesion in 3 months after surgery in the observation group was statistically lower than that in the control group(P < 0.05). Conclusion The secondary hysteroscopic exploration after intrauterine adhesion decomposition for patients with moderate to severe intrauterine adhesions helps to understand the patient's uterine recovery.Taking timely measures to prevent intrauterine adhesions from the root is worthy of clinical application.
引文
[1]吴丽珠.宫腔镜宫腔粘连分离术后放置宫内节育器联合雌-孕激素序贯疗法辅助治疗[J].中国医药科学,2017,7(20):92-94,97.
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[10]邓代荣,梁伟萍.两种方法对宫腔镜下IUA切除术后再次粘连的预防效果分析[J].浙江创伤外科,2017,22(1):81-83.
[11]朱一萍,韩凌斐,赵栋,等.宫腔镜检查对反复胚胎种植失败者再次种植妊娠率的影响[J].实用妇产科杂志,2016,32(7):507-510.
[12]罗军,吴菲,龙婷,等.仿生物理治疗预防宫腔粘连分离术后再粘连的疗效分析[J].中国医师杂志,2017,19(12):1810-1812,1816.
[13]毛艳芬,王联欢,刘淑华,等.中重度宫腔粘连患者宫腔镜术后二次探查的临床价值[J].浙江医学,2018,40(7):739-741.
[14]VanderWeerd K,Dik WA,Schrijver B,et al.Combined TCRG and TCRA TREC analysis reveals increased peripheral T-lymphocyte but constant intra-thymic proliferative history upon ageing[J].Molecular Immunology,2013,53(3):302-312.
[15]Liu X,Duan H,Wang Y,et al.Clinical characteristics and reproductive outcome following hysteroscopic adhesiolysis of patients with intrauterine adhesion-A retrospective study[J].Clinical and Experimental Obstetrics and Gynecology,2014,41(2):144-148.
[2]顾娟,王一波,曹义娟,等.重度宫腔粘连分离术后5天二次宫腔镜探查预防宫腔粘连的临床疗效[J].生殖医学杂志,2016,25(1):70-72.
[3]王锦,方慧英,胡阳秀,等.重度宫腔粘连TCRA术后1月宫腔镜探查的临床研究[J].泰山医学院学报,2017,38(7):799-800.
[4]沈丹婷,夏伟兰,吴丽雅,等.中重度宫腔粘连术后两种预防宫腔再粘连方法的临床效果比较[J].中国计划生育和妇产科,2017,9(6):44-47.
[5]周琴琴,金群俏,胡小军,等.COOK球囊联合医用几丁糖预防重度宫腔粘连术后再次宫腔粘连的临床分析[J].实用妇产科杂志,2017,33(9):716-718.
[6]王滟,梅立,谢兰,等.可吸收防粘连膜及宫腔支撑球囊联合应用在中重度宫腔粘连术后的治疗效果观察[J].实用医院临床杂志,2018,15(2):142-144.
[7]张玉婷,陈江,石兵,等.宫腔粘连分离术后预防再粘连的临床研究[J].中国妇幼健康研究,2015,26(6):1269-1272.
[8]黄乐.不同治疗方案预防中-重度宫腔粘连分离术后再粘连的疗效比较[J].医学临床研究,2017,34(2):389-391.
[9]唐静.预防重度宫腔粘连分离术后再次粘连3种方法的效果比较[J].哈尔滨医药,2017,37(3):273-274.
[10]邓代荣,梁伟萍.两种方法对宫腔镜下IUA切除术后再次粘连的预防效果分析[J].浙江创伤外科,2017,22(1):81-83.
[11]朱一萍,韩凌斐,赵栋,等.宫腔镜检查对反复胚胎种植失败者再次种植妊娠率的影响[J].实用妇产科杂志,2016,32(7):507-510.
[12]罗军,吴菲,龙婷,等.仿生物理治疗预防宫腔粘连分离术后再粘连的疗效分析[J].中国医师杂志,2017,19(12):1810-1812,1816.
[13]毛艳芬,王联欢,刘淑华,等.中重度宫腔粘连患者宫腔镜术后二次探查的临床价值[J].浙江医学,2018,40(7):739-741.
[14]VanderWeerd K,Dik WA,Schrijver B,et al.Combined TCRG and TCRA TREC analysis reveals increased peripheral T-lymphocyte but constant intra-thymic proliferative history upon ageing[J].Molecular Immunology,2013,53(3):302-312.
[15]Liu X,Duan H,Wang Y,et al.Clinical characteristics and reproductive outcome following hysteroscopic adhesiolysis of patients with intrauterine adhesion-A retrospective study[J].Clinical and Experimental Obstetrics and Gynecology,2014,41(2):144-148.