预防中、重度宫腔粘连分离术后再粘连的临床研究

发布时间：2018-06-08 22:28

本文选题：宫腔粘连 + 几丁糖　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：宫腔粘连(intrauterine adhesion，IUA)又称asherman综合征，是子宫内膜受损后修复过程中形成瘢痕组织，引起宫腔壁相互粘连，破坏宫腔的正常结构，从而引发月经过少、闭经、痛经、不孕或反复流产等严重后果，严重影响患者的生活质量。多由宫腔手术操作、盆腔感染等因素所导致。随着宫腔镜技术的不断发展，宫腔镜手术治疗宫腔粘连已得到广泛认可及应用。其具有更直观、微创、恢复快、并发症少的优点，对治疗宫腔粘连临床疗效显著。但中、重度宫腔粘连术后复发率高，临床治愈率及远期预后都不理想。本研究意以传统治疗方法做对照，通过分析术后宫腔粘连复发率、月经恢复有效率、妊娠率三个方面研究综合治疗方法对预防术后宫腔粘连的疗效。方法：对邢台市人民医院妇产科2012年9月一2013年10月58例中、重度宫腔粘连患者的临床资料进行回顾性分析。将2012年9月—2013年3月宫腔粘连患者分为A组，将2013年4月—2013年10月宫腔粘连患者分为B两组，每组29例。两组患者的平均年龄、粘连程度的构成比等一般情况对比无显著性差异（p0.05），具有可比性。术后防粘连的方法分别为放置宫内节育器+戊酸雌二醇、黄体酮人工周期组(A组)和采用宫腔内放置气囊导尿管1周+注入防黏连剂几丁糖+放置宫内节育环+戊酸雌二醇、黄体酮人工周期组(B组)。有生育要求的患者可于术后3个月取环。两组患者术后均进行严密随访，分别于术后l、3、9个月返院复查，记录其月经恢复及妊娠情况，同时进行宫腔镜检查宫腔粘连复发情况。本研究数据使用x2检验，P0．05可认为对比效果满意，有统计学意义。结果：①术后1个月复查结果为：A组宫腔粘连复发率51.7%，，月经恢复有效率55.2％；B组宫腔粘连复发率31.0%，月经恢复有效率75.9％，B组宫腔粘连复发率低于A组(P0．05)，月经恢复有效率高于A组(P0．05)，两组比较差异均有统计学意义； ②术后3个月复查结果为：A组复发率可达34.5%，月经恢复可达65.5％；B组复发率可达17.2%，月经恢复可达82.8％，B组复发率低于A组(P0．05)，月经恢复有效率高于A组(P0．05)，两组比较差异均有统计学意义； ③术后9个月复查结果为A组复发率可达24.1%，月经恢复可达75.9％，妊娠率可达29.4％；B组复发率可达10.3%，月经恢复可达89.7％，妊娠率可达55.6％，B组复发率低于A组(P0．05)，月经恢复有效率、妊娠率均高于A组(P0．05)，两组比较差异均有统计学意义。结论：本研究中采用术后于宫腔内放置气囊导尿管1周作为扩张支架，辅以几丁糖防黏连，1周后放置宫内节育器，配合雌、孕激素人工周期的综合治疗方法预防术后宫腔再粘连，其术后宫腔再粘连率明显低于对照组，月经恢复及生殖预后均高于对照组，临床治疗效果满意，值得临床推广。
[Abstract]:Objective: intrauterine adhesion (IUA), also known as Asherman syndrome, is the formation of scar tissue during the repair of endometrium, causing the adhesion of the walls of the uterine cavity and destroying the normal structure of the uterine cavity, thus causing severe consequences such as oligomenstruation, amenorrhea, dysmenorrhea, infertility or repeated abortion, which seriously affect the quality of life of the patients. With the continuous development of hysteroscopic technology, hysteroscopic surgery has been widely recognized and applied in the treatment of intrauterine adhesions with the development of hysteroscopy. It has the advantages of more intuitive, minimally invasive, quick recovery and less complications, and has a significant clinical effect on the treatment of intrauterine adhesions. However, the recurrence rate of severe uterine adhesion is high, and the postoperative recurrence rate is high. The cure rate and the long-term prognosis of the bed were not ideal. This study was compared with the traditional treatment method. By analyzing the recurrence rate of intrauterine adhesions, the effective rate of menstruation recovery and the pregnancy rate, the effect of comprehensive therapy on preventing postoperative intrauterine adhesions was studied in the three aspects.
Methods: the clinical data of 58 patients with severe adhesions in the Department of Obstetrics and Gynecology of Xingtai People's Hospital from September 2012 to October 2013 were analyzed retrospectively. The patients were divided into A group from September 2012 to 2013 3, and the patients were divided into two groups, 29 cases in each group, and the average age of the two groups. There was no significant difference in the composition of the degree of Association (P0.05). The methods of postoperative anti adhesion were intrauterine IUD + estradiol valerate, the group of progesterone (A) and 1 weeks of intrauterine urethral catheterization + intrauterine intrauterine ring + estradiol valerate and yellow valerate by placing the balloon catheter in the uterine cavity. The patients with reproductive requirements (group B). The patients with reproductive requirements could take rings 3 months after the operation. The two groups were followed up closely after the operation and were reexamined at L and 3,9 months after operation. The recovery of menstruation and pregnancy were recorded, and the hysteroscopic examination of the recurrence of intrauterine adhesions was carried out. The data of this study were compared with the x2 test, and P0.05 may be considered as comparison. The effect is satisfactory and there is statistical significance.
Results: 1 months after operation, the results were as follows: the recurrence rate of intrauterine adhesions in the A group was 51.7%, the rate of menstrual recovery was 55.2%, the recurrence rate of uterine adhesion in group B was 31%, the rate of menstrual recovery was 75.9%, and the recurrence rate of uterine cavity adhesion in group B was lower than that in group A (P0.05), and the rate of menstrual recovery was higher than that in group A (P0.05), and the difference was statistically significant in the two groups.
The reexamination results of 3 months after operation were as follows: the recurrence rate of group A was 34.5%, the recovery of menstruation could reach 65.5%, the recurrence rate of group B was 17.2%, menstrual recovery was 82.8%, the recurrence rate of group B was lower than that of group A (P0.05), and the rate of menstrual recovery was higher than that of group A (P0.05), and the difference was statistically significant in the two groups.
(3) 9 months after operation, the reexamination results were 24.1% in group A, 75.9% for menstrual recovery, 29.4% for pregnancy, 10.3% in group B, 89.7% for menstruation, and 55.6% in pregnancy rate. The recurrence rate in group B was lower than that in group A (P0.05), the rate of menstrual recovery was higher than that of group A (P0.05), and there were statistical differences in the comparison of the two groups. Learning meaning.
Conclusion: in this study, the balloon catheter was placed in the uterine cavity for 1 weeks as an expansion stent, supplemented with chitosan and anti stickiness, 1 weeks after the intrauterine device was placed, combined with the synthetic treatment of female and progestin cycles to prevent postoperative uterine adhesion. The readhesion rate of the uterine cavity after operation was significantly lower than that of the control group, the recovery of menstruation and the reproductive prognosis. All of them were higher than those of the control group. The clinical effect was satisfactory and worthy of clinical promotion.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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