聚乳酸防粘连膜联合雌孕激素用于预防宫腔粘连分离术后再粘连的临床研究

发布时间：2018-04-30 01:18

本文选题：宫腔粘连 + 聚乳酸防粘连膜　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本研究利用聚乳酸防粘连膜+宫内节育器+雌孕激素人工周期综合疗法预防术后再粘连,同时将采用传统方式治疗患者进行疗效对比,通过对患者术后宫腔粘连复发率、月经改善情况和术后妊娠率等临床参数进行对比探究聚乳酸防粘连膜在预防宫腔粘连术后再复发中的应用价值。方法:研究对象来源于2014年7月至2016年12月本院妇产科因宫腔粘连收治入院并行宫腔粘连分离术患者120例,患者总病例数为120例,根据治疗中患者采用的不同防粘连的方式,将患者分为以下几组:对照组(球囊+透明质酸钠+IUD+雌孕激素周期)和实验组(聚乳酸防粘连膜+IUD+雌孕激素周期),在治疗过程中详细记录患者宫腔粘连分度、术前月经、妊娠等情况,并对患者进行为期3-6个月的随访,收集患者术后的临床资料。所有数据利用SPSS17.0统计学软件进行统计学分析(检验水准设为P=0.05)通过对各组患者月经改善、宫腔形态恢复情况等参数进行对比与观察,研究不同防粘连方式在防止TCRA术后防粘连治疗中的差异,为今后防止宫腔粘连分离术后预防再粘连治疗方式的选择提供理论基础。结果:通过对所有病例数据进行分析及患者术后3-6个月的随访,患者对治疗效果满意,患者症状得到明显改善:1.两组患者的一般资料(年龄、宫内操作次数、孕次、病程)比较差异均无统计学意义(P值均0.05)两组患者的月经恢复情况、以及宫腔粘连分度比较差异无统计学意义(P值均0.05)2.术后对照组与实验组的月经改善情况差异比较具有统计学意义。(X2=14.371 P=0.001 P0.05)3.术后对照组与实验组的宫腔粘连再复发率差异比较具有统计学意义(X2=19.606 P0.01)4.术后对照组与实验组的宫腔形态恢复情况差异比较具有统计学意义(X2=25.378 P0.01)5.术后对照组与实验组的术后妊娠率差异比较无统计学意义(X2=0.106 P=0.744 P0.05)结论:聚乳酸防粘连膜与传统方式(球囊+透明质酸钠+IUD+雌孕激素治疗)在预防宫腔粘连术后再粘连均有较好的疗效,其中聚乳酸防粘连膜较传统方式:在降低远期术后再粘连复发率及改善宫腔形态方面具有更好的效果。可明显改善月经异常的情况,利于月经的恢复,为远期妊娠打下基础。虽然本实验未明确得出该方式可有效改善远期妊娠率,但是从数据比较以及从根本上改善粘连复发率和月经情况来看,推断其可改善妊娠率,有效的改善了因宫腔粘连所造成的生育功能障碍。但是如果要明确验证此结论还需此方法进一步的应用,增加样本量再进行数据的分析
[Abstract]:Objective: to study the prevention of postoperative recurrent adhesions by using artificial cycle therapy of estrogen and progesterone with polylactic acid anti-adhesion membrane intrauterine device, and to compare the curative effect of traditional treatment methods on the recurrence rate of postoperative intrauterine adhesions. Clinical parameters of menstrual improvement and pregnancy rate were compared to explore the value of polylactic acid anti-adhesion membrane in preventing recurrence of intrauterine adhesions. Methods: from July 2014 to December 2016, 120 patients of gynecology and obstetrics were admitted to our hospital for intrauterine adhesions. The total number of patients was 120, according to the different ways of preventing adhesion. The patients were divided into the following groups: control group (balloon sodium hyaluronate IUD estradiol and progesterone cycle) and experimental group (polylactic acid antiadhesion membrane IUD estrogen progesterone cycle). The patients were followed up for 3-6 months to collect the clinical data. All the data were statistically analyzed by SPSS17.0 statistical software (the test level was set at 0.05). By comparing and observing the parameters of menstruation improvement and uterine cavity shape recovery in each group, To study the difference of different anti-adhesion ways in preventing adhesion after TCRA, and to provide a theoretical basis for the choice of prevention and re-adhesion treatment after the separation of uterine cavity adhesion. Results: by analyzing the data of all cases and following up the patients for 3 to 6 months after operation, the patients were satisfied with the effect of treatment, and the symptoms of the patients were obviously improved by 1: 1. There was no significant difference in general data (age, times of intrauterine operation, number of pregnancies, course of disease) between the two groups (P = 0.05). There was no significant difference in menstrual recovery between the two groups, and there was no significant difference in the degree of intrauterine adhesion between the two groups. The difference of menstrual improvement between the control group and the experimental group was statistically significant. The recurrence rate of intrauterine adhesions in the control group and the experimental group was significantly higher than that in the control group (P < 0.01). There was significant difference in the recovery of uterine cavity between the control group and the experimental group after operation. There was no significant difference in the postoperative pregnancy rate between the control group and the experimental group. Conclusion: Polylactic acid anti-adhesion membrane and traditional (balloon hyaluronate sodium IUD estradiol progesterone therapy) in the prevention of intrauterine adhesion after operation are not statistically significant. Re-adhesion has better curative effect. Polylactic acid antiadhesion membrane is more effective in reducing recurrence rate and improving uterine cavity morphology. Can obviously improve the menstrual abnormal situation, conducive to the recovery of menstruation, lay the foundation for long-term pregnancy. Although it is not clear in this study that this method can effectively improve the long-term pregnancy rate, it is inferred from the comparison of the data and the fundamental improvement of the relapse rate of adhesions and menstruation that it can improve the pregnancy rate. It can effectively improve the fertility dysfunction caused by intrauterine adhesion. But if we want to verify this conclusion clearly, we need further application of this method, increase the sample size and then analyze the data.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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