不同方法治疗宫腔粘连的临床效果
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摘要
目的探讨不同方法治疗宫腔粘连(IUA)的临床效果。方法选取2013年1月～2016年12月在我院妇科治疗的105例IUA患者作为研究对象,按治疗方法分为三组,每组各35例。Ⅰ组接受宫腔镜下宫腔粘连分离术联合上环术治疗;Ⅱ组接受宫腔镜下宫腔粘连分离术联合COOK球囊扩张治疗14 d取出;Ⅲ组接受宫腔镜下宫腔粘连分离术联合COOK球囊扩张治疗7 d取出;三组均同时服用戊酸雌二醇联合地屈孕酮治疗3个月,3个月后复查。比较三组治疗前后子宫内膜增长,月经量变化,治疗效果,凝血功能相关指标及再粘连发生情况。结果Ⅱ及Ⅲ组临床治疗总有效率明显高于Ⅰ组,差异有统计学意义(P<0.05),但Ⅱ及Ⅲ组比较,差异无统计学意义(P>0.05);术前各组评分比较,差异无统计学意义(P>0.05),Ⅱ及Ⅲ组的术后评分低于Ⅰ组,术后评分改善率高于Ⅰ组,差异均有统计学意义(P<0.05);Ⅱ及Ⅲ组月经好转率明显高于Ⅰ组(P<0.05),但Ⅱ及Ⅲ组间比较,差异无统计学意义(P>0.05)。结论宫腔镜下宫腔粘连分离术联合球囊扩张治疗IUA患者,可显著提高治疗效果,改善患者预后,临床优势明显。
Objective To study the clinical effect of different methods in the treatment of intrauterine adhesions(IUA).Methods A total of 105 cases of IUA treated in our hospital from January 2013 to December 2016 were selected and divided into 3 groups according to the treatment method,35 cases in each group.The group Ⅰ received hysteroscopic adhesion separation combined with superior ring surgery.The group Ⅱ received hysteroscopic hysteroscopy combined with COOK balloon dilation for 14 days.The group Ⅲ was treated with hysteroscopic adhesions separation and COOK balloon dilation for 7 days.All the three groups were treated with Estradiol Valerate combined with Diproprogesterone for 3 months.Before and after treatment in the three groups with the endometrial growth,menstrual volume,therapeutic effect,coagulation function related indexes and the occurrence of re-adhesion were compared.Results The total effective rate of clinical treatment in group Ⅱand Ⅲ were significantly higher than that in group Ⅰ(P<0.05),but there was no significant difference between group Ⅱand Ⅲ(P>0.05).There was no significant difference in the score of each group before operation(P>0.05).The postoperative scores of group Ⅱand Ⅲ were lower than that of group Ⅰ,and the improvement rate of postoperative score was higher than that of group Ⅰ(P<0.05).The menstrual change rate of groupⅡand Ⅲ were significantly higher than that of group Ⅰ(P<0.05),but there was no significant difference between group Ⅱand Ⅲ(P>0.05).Conclusion Hysteroscopy combined with balloon dilation in the treatment of IUA can significantly improve the therapeutic effect and improve the prognosis of patients with obvious clinical advantages.
Objective To study the clinical effect of different methods in the treatment of intrauterine adhesions(IUA).Methods A total of 105 cases of IUA treated in our hospital from January 2013 to December 2016 were selected and divided into 3 groups according to the treatment method,35 cases in each group.The group Ⅰ received hysteroscopic adhesion separation combined with superior ring surgery.The group Ⅱ received hysteroscopic hysteroscopy combined with COOK balloon dilation for 14 days.The group Ⅲ was treated with hysteroscopic adhesions separation and COOK balloon dilation for 7 days.All the three groups were treated with Estradiol Valerate combined with Diproprogesterone for 3 months.Before and after treatment in the three groups with the endometrial growth,menstrual volume,therapeutic effect,coagulation function related indexes and the occurrence of re-adhesion were compared.Results The total effective rate of clinical treatment in group Ⅱand Ⅲ were significantly higher than that in group Ⅰ(P<0.05),but there was no significant difference between group Ⅱand Ⅲ(P>0.05).There was no significant difference in the score of each group before operation(P>0.05).The postoperative scores of group Ⅱand Ⅲ were lower than that of group Ⅰ,and the improvement rate of postoperative score was higher than that of group Ⅰ(P<0.05).The menstrual change rate of groupⅡand Ⅲ were significantly higher than that of group Ⅰ(P<0.05),but there was no significant difference between group Ⅱand Ⅲ(P>0.05).Conclusion Hysteroscopy combined with balloon dilation in the treatment of IUA can significantly improve the therapeutic effect and improve the prognosis of patients with obvious clinical advantages.
引文
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[10]陈晔.大剂量戊酸雌二醇预防重度宫腔粘连分离术后复发的疗效[J].实用妇科内分泌杂志(电子版),2016,3(13):166,168.
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[13]马剑霞,周凤,曾贵红.宫腔球囊联合戊酸雌二醇预防宫腔粘连分离术后复发的临床观察[J].中国现代医生,2018,12(1):62-64.
[14]周丽叶,华海红.宫腔粘连分离术后两种防粘连方法的临床分析[J].中国医药科学,2017,7(14):86-89.
[15]黄俊花,陈晓红.重度宫腔粘连分离术后应用双节育器加防粘连膜预防宫腔再粘连的效果分析[J].中国医师杂志,2016,18(8):1231-1233.
[2]左欣,杨慧云,陈芳,等.两种方法预防宫腔粘连分离术后再粘连疗效分析[J].实用妇产科杂志,2015,31(7):540-542.
[3]黄俊花,陈晓红.重度宫腔粘连分离术后应用双节育器加防粘连膜预防宫腔再粘连的效果分析[J].中国医师杂志,2016,18(8):1231-1233.
[4]中华医学会妇产科学分会.宫腔粘连临床诊疗中国专家共识[J].中华妇产科杂志,2015,50(12):881-887.
[5]艾细雄,李满超,曾海涛,等.两种宫腔镜手术方式治疗宫腔粘连后的妊娠结局分析[J].国际妇产科学杂志,2017,44(5):594-598.
[6]张玉婷,陈江,曹杰,等.宫腔镜下手术治疗宫腔粘连的疗效及宫腔粘连的危险因素分析[J].现代生物医学进展,2016,16(11):2120-2122.
[7]Xiao S,Wan Y,Xue M,et al.Etiology,treatment,and reproductive prognosis of women with moderate-to-severe intrauterine adhesions[J].Int J Gynaecol Obstet,2014,125(2):121-124.
[8]冯缵冲.新编不孕不育治疗学[M].上海:复旦大学出版社,2011:59-161.
[9]陈瑞欣,王彦龙,骆亚平.宫内节育器联合迪康防粘连膜在中重度宫腔粘连术中的应用效果[J].中国妇幼保健,2018,33(1):216-218.
[10]陈晔.大剂量戊酸雌二醇预防重度宫腔粘连分离术后复发的疗效[J].实用妇科内分泌杂志(电子版),2016,3(13):166,168.
[11]何金华,席予凡.不同方法在重度宫腔粘连治疗中的疗效观察[J].中国妇幼健康研究,2016,27(9):1151-1152.
[12]Tsui K.H,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.
[13]马剑霞,周凤,曾贵红.宫腔球囊联合戊酸雌二醇预防宫腔粘连分离术后复发的临床观察[J].中国现代医生,2018,12(1):62-64.
[14]周丽叶,华海红.宫腔粘连分离术后两种防粘连方法的临床分析[J].中国医药科学,2017,7(14):86-89.
[15]黄俊花,陈晓红.重度宫腔粘连分离术后应用双节育器加防粘连膜预防宫腔再粘连的效果分析[J].中国医师杂志,2016,18(8):1231-1233.