摘要
目的观察中、重度宫腔粘连患者宫腔粘连电切术后不同干预方案的临床效果。方法选取174例中、重度宫腔粘连患者(中度粘连121例,重度粘连53例)作为研究对象,患者均接受宫腔粘连电切术治疗。根据术后预防再粘连方案将患者分为凝胶组(采用自交联透明质酸钠凝胶方案)、球囊组(采用Foley球囊方案)和联合组(采用自交联透明质酸钠凝胶联合Foley球囊方案)。观察并比较3组术后粘连复发、月经模式改变情况,并随访有生育要求患者的妊娠结局及产科并发症发生情况。采用Logistic回归分析探讨宫腔粘连程度、宫腔操作次数、月经模式、年龄对妊娠结局的影响。结果联合组术后再粘连发生率低于凝胶组、球囊组,差异有统计学意义(P<0.05);3组术后月经模式改变情况及术后妊娠率比较,差异无统计学意义(P>0.05)。Logistic回归分析结果显示,术前宫腔粘连程度和术后月经模式为中、重度宫腔粘连患者妊娠结局的独立影响因素(P<0.05)。结论自交联透明质酸钠凝胶联合Foley球囊预防宫腔再粘连的效果优于单独使用自交联透明质酸钠凝胶或Foley球囊,重度宫腔粘连患者的预后相对较差,术前宫腔粘连程度和术后月经模式会影响患者的妊娠结局。
Objective To observe the clinical effects of different intervention methods after transcervical resection of intrauterine adhesion in patients with moderate to severe intrauterine adhesion.Methods A total of 174 patients with moderate to severe intrauterine adhesion were selected as study objects,including 121 cases with moderate adhesion,and 53 cases with severe adhesion,all of them accepted electrosurgical treatment of intrauterine adhesion.According to the method of preventing re-adhesion after operation,they were divided into gel group(self-crosslinked sodium hyaluronate gel regimen),balloon group(Foley balloon regimen)and combination group(self-crosslinked sodium hyaluronate gel regimen combined with Foley balloon regimen).The recurrence conditions of postoperative adhesion and changes of menstrual pattern were observed and compared among the three groups,and the pregnancy outcomes and obstetric complications of the patients with fertility requirements were followed up.Logistic regression analysis was used to analyze the effects of the degree of intrauterine adhesions,the number of intrauterine operation,menstrual pattern and age on pregnancy outcomes.Results The incidence of postoperative re-adhesion in the combination group was lower than that in the gel group and the balloon group(P<0.05).There were no statistical significances in the change of menstrual pattern and pregnancy rate among the three groups(P>0.05).Logistic regression analysis showed that the degree of intrauterine adhesions before operation and postoperative menstrual patterns after operation were independent factors affecting pregnancy(P<0.05).Conclusion Self-crosslinking sodium hyaluronate gel combined with Foley balloon has better efficacy than self-crosslinking sodium hyaluronate gel or Foley balloon alone in preventing intrauterine readhesion.The recovery of patients with severe adhesions is relatively poor.The preoperative degree of intrauterine adhesions and postoperative menstrual patterns will affect the pregnancy outcomes of patients with intrauterine adhesions.
作者
谷楠楠
杨荷
陈继明
施如霞
GU Nannan;YANG He;CHEN Jiming;SHI Ruxia(Graduate School of Bengbu Medical College,Bengbu,Anhui,233030;Changzhou Second People′s Hospital Affiliated to Nanjing Medical University,Changzhou,Jiangsu,213003)
出处
《实用临床医药杂志》
CAS
2021年第17期128-132,共5页
Journal of Clinical Medicine in Practice
基金
江苏省“333工程”科研资助项目(BRA2019161)
江苏省博士后科研资助计划(2019K064)
江苏省常州市卫生计生委重大科技项目(ZD201812)
南京医科大学康达学院2018年度教育研究课题(KD2018JYYJY055)。
关键词
宫腔粘连
透明质酸钠
Foley球囊
月经模式
妊娠结局
intrauterine adhesion
sodium hyaluronate
Foley balloon
menstrual patterns
pregnancy outcome
作者简介
通信作者:施如霞,E-mail:rena@live.com。
