羊膜球囊在宫腔粘连电切术后的临床应用

发布时间：2018-06-17 22:37

本文选题：宫腔粘连 + 羊膜球囊　；参考：《实用妇产科杂志》2015年10期

【摘要】：目的:从临床应用的安全性、有效性评价羊膜作为生物支架在宫腔粘连(IUA)电切术(TCRA)后放置于宫腔预防再粘连、促进宫腔内膜化的价值。方法:经宫腔镜检查确诊为中重度IUA且随访资料完整的患者47例,按照随机的原则分为宫腔镜下TCRA后Foley球囊组(21例)、宫腔镜下TCRA后羊膜球囊组(26例)。记录宫腔镜下TCRA术中并发症、术中出血量、手术时间、膨宫液用量以及TCRA术后发热、盆腔VAS评分、术后阴道流血时间,术后球囊脱落脱落情况、月经恢复情况;术后宫腔深度的改善、IUA评分改善、IUA再发情况以及宫腔内膜覆盖满意程度,并随访术后妊娠情况。结果:两组术中术后各项指标比较差异均无统计学意义(P0.05)。羊膜球囊组术后IUA评分降低较Foley球囊组有显著优势,分别降低4.02±0.31分与2.51±0.52分(P0.05);月经恢复正常比例更高,分别为80.7%与52.4%(P0.05);宫腔再粘连率较Foley球囊组明显降低,分别为3.8%与42.9%(P0.05);宫腔内膜化满意程度高于Foley球囊组,满意率分别为88.4%与47.6%(P0.05)。总妊娠率为25.5%(12/47),羊膜球囊组(34.6%,9/26)高于Foley球囊组(14.3%,3/21),差异无统计学意义(P0.05)。结论:羊膜在TCRA后放置宫腔起到生物支架作用,在降低再粘连率、IUA评分及宫腔内膜化满意程度方面有较好效果,临床应用安全。
[Abstract]:Objective: to evaluate the value of amniotic membrane (amniotic membrane) being placed in the uterine cavity after electroresection of intrauterine adhesion (IUAA) to prevent re-adhesion and promote endometriosis. Methods: a total of 47 patients with moderate and severe IUA confirmed by hysteroscopy were divided into two groups according to the random principle: the Foley balloon group (21 cases) and the amniotic membrane balloon group (26 cases). Intraoperative complications, intraoperative bleeding, time of operation, dosage of dilatation fluid, postoperative fever, pelvic VAS score, vaginal bleeding time, balloon shedding and menstrual recovery were recorded under hysteroscopy. The improvement of uterine cavity depth and the improvement of IUA score improved the recurrence of IUA and the satisfactory degree of endometrial coverage, and followed up the pregnancy after operation. Results: there was no significant difference in the indexes between the two groups (P 0.05). The decrease of IUA score in amniotic balloon group was significantly higher than that in Foley balloon group, which decreased 4.02 卤0.31 and 2.51 卤0.52 points (P 0.05), and the proportion of menstrual recovery was higher (80.7% vs 52.4%, P 0.05), and the rate of intrauterine re-adhesion was significantly lower than that in Foley balloon group. The satisfactory degree of endometriosis was higher in the Foley balloon group than in the Foley balloon group, and the satisfaction rate was 88.4% and 47.6%, respectively. The total pregnancy rate was 25. 5 / 47. The amniotic membrane balloon group was 34.695 / 26) higher than the Foley balloon group. There was no significant difference (P 0. 05). Conclusion: amniotic membrane placement in the uterine cavity after TCRA has a good effect on reducing the rate of re-adhesion and the satisfactory degree of endometriosis, and is safe in clinical application.
【作者单位】：宁夏医科大学总医院;宁夏医科大学生育力保持教育部重点实验室;山东大学齐鲁医院;
【基金】：宁夏自然科学基金项目(编号:NZ13142)
【分类号】：R713.4

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