两种中度宫腔粘连治疗方案的临床对照研究

Comparison between two moderate intrauterine adhesions treatment methods

摘要:

目的 比较两种中度宫腔粘连治疗方案的疗效。 方法 将120例中度宫腔粘连患者随机分为两组，研究组：60例，采用治疗方案A：宫腔粘连分离术后立即宫腔内留置Foley导管并注入2 mL透明质酸钠凝胶（HA），术后第3天再次于宫腔内注入2 mL HA，术后第4天取出Foley导管并上宫型环，同时予雌孕激素人工周期治疗3个月；对照组60例，采用治疗方案B：除术后第3天宫腔内未注入HA外，其余治疗方法均同研究组。所有患者均于术后第3次月经干净3～7 d内复查宫腔镜，观察两组的宫腔粘连复发情况及月经改善情况，以初步评价两种治疗方案的疗效。结果 研究组粘连复发率15％，月经改善率90％；对照组粘连复发率31.67％，月经改善率71.67％，两组比较差异具有显著性（P 值均<0.05）。 结论 对于中度宫腔粘连的患者，治疗方案A的疗效明显优于治疗方案B，值得进一步探讨其临床推广应用价值。

Abstract:

【Objective】 To compare two different methods of ancillary treatment following hysteroscopic adhesiolysis in patients with moderate intrauterine adhesions (IUA). 【Methods】 A total of 120 patients with moderate IUA were randomly assigned into two groups. In the experimental group, patients were treated with therapeutic regimen A, in which, a Foley catheter balloon was used after adhesiolysis procedure followed by injection of hyaluronic acid gel (HA). A second injection of HA into the uterine cavity was carried out on the third day postoperatively. The Foley catheter was removed and replaced by an intrauterine contraceptive device on the fourth day. Artificial cycle hormonal therapy was applied for the next three months. In control group, patients were treated with therapeutic regimen B, which was similar to regimen A except that the HA was only injected once (after adhesiolysis procedure). All the patients underwent second-look hysteroscopy after 3 cycles of hormonal therapy. Menstruation improvement and recurrence of adhesions were used to determine the efficacy of these different regimens. 【Results】 In the experimental group, menstrual improvement rate was improved in 90% of the patients compared to only 71.67% in the control group (P <0.05). The recurrent adhesions rate was 15% in the experimental group compared to 31.67% in control group (P <0.05). 【Conclusion】 Therapeutic regimen A has a better clinical outcome than that of regimen B as ancillary treatment following hysteroscopic adhesiolysis in patients with moderate IUA.