中重度宫腔粘连宫腔镜电切术后两种方案预防再粘连临床研究
|
摘要
目的:对于中重度宫腔粘连患者比较两种治疗方案的效果。方法:将120例中重度宫腔粘连患者随机分为两组,对照组60例,患者宫腔镜宫腔粘连切除术后直接宫内置入宫内节育器;研究组60例,患者宫腔镜宫腔粘连切除术后在宫腔内注射透明质酸钠2ml,然后宫腔放置球囊导管(剪去球囊顶端),球囊充水3~5ml,术后3d取出球囊并置入宫内节育器1枚。两组同时予人工周期治疗3个月。术后患者均按要求进行随访3个月,复查宫腔镜观察并比较两组宫腔形态恢复情况、再粘连发生情况及感染、子宫穿孔、大出血等并发症发生情况及术后妊娠情况。结果:研究组有效率91.7%高于对照组的76.7%(P<0.05)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。对照组患者术后21例成功受孕,妊娠率为35%(21/60),研究组患者术后24例成功受孕,妊娠率40%(24/60),两组术后妊娠率比较差异无统计学意义(P>0.05)。结论:宫腔镜宫腔粘连切除术后放置球囊和透明质酸钠可有效预防中重度宫腔粘连的术后复发。
Objective:To compare two different methods for preventing intrauterine adhesion following transcervical resection of adhesions(TCRA)in patients with moderate and severe intrauterine adhesions(IUA).Methods:A total of 120 patients with moderate and severe IUA were randomly assigned into two groups.In the control group,60 patients were placed intrauterine contraceptive device(IUD)after TCRA.In the Study group,a Foley catheter balloon was used after adhesiolysis procedure followed by injection of hyaluronic acid gel(HA).The Foley catheter was removed and replaced by an intrauterine contraceptive device on the third day.Artificial cycle hormonal therapy was applied for the next three months.All the patients underwent second-look hysteroscopy after 3 cycles of hormonal therapy.The recurrence of adhesions,Complications such as infection,uterine perforation,hemorrhage,pregnancy rate were followed up.Results:In the study group,the total effective rate(including cure and better)was 91.7%.In the control group,the total effective rate(including cure and better)was 76.7%.Effective rate of control group were remarkably lower than the study groups(P<0.05).There was no differences among two group in complications.Pregnancy rate of control group was 35%,pregnancy rate of study group was 40%.Conclusion:The hyaluronic acid and folley balloon are all good for preventing intrauterine adhesions after TCRA.
Objective:To compare two different methods for preventing intrauterine adhesion following transcervical resection of adhesions(TCRA)in patients with moderate and severe intrauterine adhesions(IUA).Methods:A total of 120 patients with moderate and severe IUA were randomly assigned into two groups.In the control group,60 patients were placed intrauterine contraceptive device(IUD)after TCRA.In the Study group,a Foley catheter balloon was used after adhesiolysis procedure followed by injection of hyaluronic acid gel(HA).The Foley catheter was removed and replaced by an intrauterine contraceptive device on the third day.Artificial cycle hormonal therapy was applied for the next three months.All the patients underwent second-look hysteroscopy after 3 cycles of hormonal therapy.The recurrence of adhesions,Complications such as infection,uterine perforation,hemorrhage,pregnancy rate were followed up.Results:In the study group,the total effective rate(including cure and better)was 91.7%.In the control group,the total effective rate(including cure and better)was 76.7%.Effective rate of control group were remarkably lower than the study groups(P<0.05).There was no differences among two group in complications.Pregnancy rate of control group was 35%,pregnancy rate of study group was 40%.Conclusion:The hyaluronic acid and folley balloon are all good for preventing intrauterine adhesions after TCRA.
引文
[1]Di Spiezio Sardo A,Calagna G,Scognamiglio M,et al.Prevention of intrauterine post-surgical adhesions in hysteroscopy.A systematic review[J].Eur J Obstet Gynecol Reprod Biol,2016,203:182-192.
[2]范鹏莺.宫腔镜手术配合中药灌肠治疗宫腔粘连70例[J].陕西中医,2010,31(7):780-781.
[3]March CM,Israel R,March AD.Hysteroscopic management of intrauterine adhesions[J].Am J Obstet Gynecol,1978,130(6):653-657.
[4]王茜,任国平,毕春燕.预防宫腔粘连术后再粘连方案的效果观察[J].临床误诊误治,2011,24(9):29-30.
[5]Rein DT,Schmidt T,Hess AP,et al.Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage[J].J Minim Invasive Gynecol,2011,18(6):774-778.
[6]Hooker AB,Lemmers M,Thurkow AL,et al.Systematic review and meta-analysis of intrauterine adhesions after miscarriage:prevalence,risk factors and long-term reproductive outcome[J].Hum Reprod Up Date,2014,20(2):262-278.
[7]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.
[8]Healy MW,Schexnayder B,Connell MT,et al.Intrauterine adhesion prevention after hysteroscopy:a systematic review and meta-analysis[J].Am J Obstet Gynecol,2016,215(3):267-275.
[9]Bosteels J,Weyers S,Kasius J,et al.Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility[J].Cochrane Database Syst Rev,2015,9(11):CD011110.
[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]唐旭,葛春晓.宫腔粘连诊治的研究进展[J].中国微创外科杂志,2005,5(10):935-937.
[12]Myers EM,Hurst BS.Comprehensive management of severe Asherman syndrome and amenorrhea[J].Fertil Steril,2012,97(1):160-164.
[13]Conforti A,Alviggi C,Mollo A,et al.The management of Asherman syndrome:a review of literature[J].Reprod Biol Endocrinol,2013,11:118.
[14]Pabuccu R,Onalan G,Kaya C,et al.Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopicadhesiolysis of intrauterine synechiae[J].Fertil Steril,2008,90(5):1973-1977.
[15]Robinson JK,Colimon LM,Isaacson KB.Postoperative adhesiolysis therapy for intrauterine adhesions(Asherman's syndrome)[J].Fertil Steril,2008,90(2):409-414.
[16]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.
[17]谢秀英,朱天恒,李龑萍,等.宫腔镜手术并发症32例临床分析[J].陕西医学杂志,2014,43(2):168-170.
[18]中华医学会妇产科学分会妇科内镜学组.妇科宫腔镜诊治规范[J].中华妇产科杂志,2012,47(7):555-558.
[19]朱一萍,刘蓓,韩凌斐,等.不同程度宫腔粘连宫腔镜术后的转归分析[J].华中科技大学学报:医学版,2016,45(5):551-554.
[20]柳鑫,段华.宫腔粘连临床特点及治疗结局[J].医学研究杂志,2014,43(8):86-89.
[21]汤一群,段华,汪沙,等.中重度宫腔粘连术后妊娠率及其影响因素分析[J].中国计划生育和妇产科,2017,9(1):37-41.
[22]Kasius A,Smit JG,Torrance HL,et al.Endometrial thickness and pregnancy rates after IVF:a systematic review and meta-analysis[J].Hum Reprod Update,2014,20(4):530-541.
[2]范鹏莺.宫腔镜手术配合中药灌肠治疗宫腔粘连70例[J].陕西中医,2010,31(7):780-781.
[3]March CM,Israel R,March AD.Hysteroscopic management of intrauterine adhesions[J].Am J Obstet Gynecol,1978,130(6):653-657.
[4]王茜,任国平,毕春燕.预防宫腔粘连术后再粘连方案的效果观察[J].临床误诊误治,2011,24(9):29-30.
[5]Rein DT,Schmidt T,Hess AP,et al.Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage[J].J Minim Invasive Gynecol,2011,18(6):774-778.
[6]Hooker AB,Lemmers M,Thurkow AL,et al.Systematic review and meta-analysis of intrauterine adhesions after miscarriage:prevalence,risk factors and long-term reproductive outcome[J].Hum Reprod Up Date,2014,20(2):262-278.
[7]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.
[8]Healy MW,Schexnayder B,Connell MT,et al.Intrauterine adhesion prevention after hysteroscopy:a systematic review and meta-analysis[J].Am J Obstet Gynecol,2016,215(3):267-275.
[9]Bosteels J,Weyers S,Kasius J,et al.Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility[J].Cochrane Database Syst Rev,2015,9(11):CD011110.
[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]唐旭,葛春晓.宫腔粘连诊治的研究进展[J].中国微创外科杂志,2005,5(10):935-937.
[12]Myers EM,Hurst BS.Comprehensive management of severe Asherman syndrome and amenorrhea[J].Fertil Steril,2012,97(1):160-164.
[13]Conforti A,Alviggi C,Mollo A,et al.The management of Asherman syndrome:a review of literature[J].Reprod Biol Endocrinol,2013,11:118.
[14]Pabuccu R,Onalan G,Kaya C,et al.Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopicadhesiolysis of intrauterine synechiae[J].Fertil Steril,2008,90(5):1973-1977.
[15]Robinson JK,Colimon LM,Isaacson KB.Postoperative adhesiolysis therapy for intrauterine adhesions(Asherman's syndrome)[J].Fertil Steril,2008,90(2):409-414.
[16]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.
[17]谢秀英,朱天恒,李龑萍,等.宫腔镜手术并发症32例临床分析[J].陕西医学杂志,2014,43(2):168-170.
[18]中华医学会妇产科学分会妇科内镜学组.妇科宫腔镜诊治规范[J].中华妇产科杂志,2012,47(7):555-558.
[19]朱一萍,刘蓓,韩凌斐,等.不同程度宫腔粘连宫腔镜术后的转归分析[J].华中科技大学学报:医学版,2016,45(5):551-554.
[20]柳鑫,段华.宫腔粘连临床特点及治疗结局[J].医学研究杂志,2014,43(8):86-89.
[21]汤一群,段华,汪沙,等.中重度宫腔粘连术后妊娠率及其影响因素分析[J].中国计划生育和妇产科,2017,9(1):37-41.
[22]Kasius A,Smit JG,Torrance HL,et al.Endometrial thickness and pregnancy rates after IVF:a systematic review and meta-analysis[J].Hum Reprod Update,2014,20(4):530-541.