宫腔粘连电切术后不同干预方案的临床效果观察

谷楠楠; 杨荷; 陈继明; 施如霞

doi:10.7619/jcmp.20211672

宫腔粘连电切术后不同干预方案的临床效果观察

谷楠楠¹,
杨荷²,
陈继明²,
施如霞^{1, 2, ,}

1.
蚌埠医学院研究生院，安徽蚌埠, 233030
2.
南京医科大学附属常州第二人民医院, 江苏常州, 213003

基金项目:

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

详细信息

通讯作者:
施如霞, E-mail: rena@live.com

中图分类号: R711.74;R713.4
计量
- 文章访问数: 248
- HTML全文浏览量: 133
- PDF下载量: 7
出版历程
- 收稿日期: 2021-04-20
- 网络出版日期: 2021-10-12
- 发布日期: 2021-09-14

Observation in clinical effects of different intervention schemes after electrotomy of intrauterine adhesion

GU Nannan¹,
YANG He²,
CHEN Jiming²,
SHI Ruxia^{1, 2, ,}

1.
Graduate School of Bengbu Medical College, Bengbu, Anhui, 233030
2.
Changzhou Second People′s Hospital Affiliated to Nanjing Medical University, Changzhou, Jiangsu, 213003

摘要

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。
- 宫腔粘连 /
- 透明质酸钠 /
- Foley球囊 /
- 月经模式 /
- 妊娠结局
Abstract:
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).
Results 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.
- intrauterine adhesion /
- sodium hyaluronate /
- Foley balloon /
- menstrual patterns /
- pregnancy outcome

HTML全文

表 1 不同程度宫腔粘连患者的临床资料比较(x±s)

组别	n	年龄/岁	宫腔操作次数/次	流产次数/次
中度组	121	31.04±5.15	1.54±0.58	1.96±1.21
重度组	53	31.45±5.53	2.79±1.17^*	2.81±1.53^*
与中度比较，*P<0.05。

下载: 导出CSV

表 2 3组患者干预后临床疗效比较(x±s)[n(%)]

组别	n	年龄	中度粘连	重度粘连
凝胶组	40	32.84±4.97	30(75.00)	10(25.00)
球囊组	84	30.53±4.78	57(67.86)	27(32.14)
联合组	50	31.04±6.14	34(68.00)	16(32.00)

下载: 导出CSV

表 3 3组TCRA术后再粘连预防效果比较[n(%)]

组别	n	再粘连	无粘连
凝胶组	40	12(30.00)	28(70.00)
球囊组	84	26(30.95)	58(69.05)
联合组	50	5(10.00)^*#	45(90.00)^*#
与凝胶组比较, *P < 0.05; 与球囊组比较, #P < 0.05。

下载: 导出CSV

表 4 3组手术前后月经模式情况比较[n(%)]

组别	n	术前月经模式		术后月经模式
组别	n	闭经	月经量少	恢复正常	月经量少	闭经
凝胶组	39	2(5.13)	37(94.87)	29(74.36)	10(25.64)	0
球囊组	77	5(6.49)	72(93.51)	60(77.92)	17(22.08)	0
联合组	48	4(8.33)	44(91.67)	39(81.25)	9(18.75)	0

下载: 导出CSV

表 5 宫腔粘连患者妊娠结局的单因素分析

因素		n	妊娠	未妊娠	χ²	P
术前宫腔粘连程度	中度	48	37	11	10.899	0.001
	重度	32	13	19
术前月经模式	正常	3	2	1	-	1.000
	月经量减少	72	45	27
	闭经	5	3	2
术后月经模式	正常	46	37	9	14.85	< 0.001
	月经量减少	34	13	21
	闭经	0	0	0
术后再粘连	有	13	8	5	-	1.000
	无	67	42	25
宫腔操作次数	>2次	20	8	12	4.718	0.030
	≤2次	60	42	18
年龄	>30岁	34	20	14	0.341	0.559
	≤30岁	46	30	16

下载: 导出CSV

表 6 影响中重度宫腔粘连患者妊娠结局的二元Logistic回归分析

变量	β	SE	Wald	P	OR	95%CI
术前宫腔粘连程度	1.398	0.676	4.280	0.039	4.048	1.076~15.225
宫腔操作次数	-0.310	0.765	0.164	0.686	0.734	0.164~3.287
术后月经模式	-0.837	0.278	9.074	0.003	0.433	0.251~0.747
常数	1.289	1.833	0.495	0.482	3.629	—

下载: 导出CSV

参考文献(20)

[1]	EVANS-HOEKER E A, YOUNG S L. Endometrial receptivity and intrauterine adhesive disease[J]. Semin Reprod Med, 2014, 32(5): 392-401. doi: 10.1055/s-0034-1376358
[2]	CHEN L, XIAO S, HE S, et al. Factors that impact fertility after hysteroscopic adhesiolysis for intrauterine adhesions and amenorrhea: a retrospective cohort study[J]. J Minim Invasive Gynecol, 2020, 27(1): 54-59. doi: 10.1016/j.jmig.2018.12.023
[3]	KOU L, JIANG X, XIAO S, et al. Therapeutic options and drug delivery strategies for the prevention of intrauterine adhesions[J]. J Control Release, 2020, 318: 25-37. doi: 10.1016/j.jconrel.2019.12.007
[4]	中华医学会妇产科学分会. 宫腔粘连临床诊疗中国专家共识[J]. 中华妇产科杂志, 2015, 50(12): 881-887. doi: 10.3760/cma.j.issn.0529-567x.2015.12.001
[5]	陈芳, 张颖, 成九梅. 中-重度宫腔粘连分离术后妊娠结局分析[J]. 国际妇产科学杂志, 2019, 46(3): 326-330. doi: 10.3969/j.issn.1674-1870.2019.03.020
[6]	李岩, 梁琛, 南燕燕, 等. 高雌二醇片/雌二醇地屈孕酮片应用于稽留流产术后恢复效果[J]. 中国计划生育学杂志, 2021, 29(5): 914-916, 920.
[7]	王玉欣. TCRA术+辅助治疗对宫腔粘连的临床分析[D]. 唐山: 华北理工大学, 2019.
[8]	许阡, 王祎祎, 臧春逸. 宫腔粘连临床病因学及诊疗研究进展[J]. 国际妇产科学杂志, 2021, 48(2): 224-229, 240. https://www.cnki.com.cn/Article/CJFDTOTAL-GWVC202102025.htm
[9]	HOOKER A B, LEMMERS M, THURKOW A L, et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome[J]. Hum Reprod Update, 2014, 20(2): 262-278. doi: 10.1093/humupd/dmt045
[10]	XIONG Q, ZHANG T, SU S. A network meta-analysis of efficacy of different interventions in the prevention of postoperative intrauterine adhesions[J]. Clin Transl Sci, 2020, 13(2): 372-380. doi: 10.1111/cts.12721
[11]	WANG Y Q, SONG X H, WU S L, et al. Comparison of autocross-linked hyaluronic acid gel and intrauterine device for preventing intrauterine adhesions in infertile patients: a randomized clinical trial[J]. Gynecol Minim Invasive Ther, 2020, 9(2): 74-80. doi: 10.4103/GMIT.GMIT_103_19
[12]	刘瑾, 梁秋妮, 黄燕宇, 等. 宫腔粘连分离术后宫腔放置节育器与球囊支架预防再粘连的疗效分析[J]. 中国实用医药, 2020, 15(20): 144-146. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202020061.htm
[13]	曹杨, 邓姗, 陈蓉, 等. 延长放置宫腔球囊支架预防中重度宫腔粘连术后复粘的临床初探[J]. 生殖医学杂志, 2019, 28(1): 29-35. https://www.cnki.com.cn/Article/CJFDTOTAL-SZYX201901007.htm
[14]	ZHOU Q, SHI X, SARAVELOS S, et al. Auto-cross-linked hyaluronic acid gel for prevention of intrauterine adhesions after hysteroscopic adhesiolysis: a randomized controlled trial[J]. J Minim Invasive Gynecol, 2021, 28(2): 307-313. doi: 10.1016/j.jmig.2020.06.030
[15]	方淑英, 孙欢瑾, 张晖, 等. 自交联透明质酸钠凝胶预防中重度宫腔粘连分离术后再粘连[J]. 中国微创外科杂志, 2020, 26(6): 494-497. doi: 10.3969/j.issn.1009-6604.2020.06.003
[16]	彭华, 何丽, 黄革, 等. 不同宫内装置方法预防宫腔镜下宫腔粘连分离术后再粘连的临床疗效分析[J]. 广西医科大学学报, 2020, 37(8): 1557-1561. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD202008033.htm
[17]	ZHENG F, XIN X, HE F, et al. Meta-analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations[J]. Exp Ther Med, 2020, 19(4): 2672-2678. http://www.ingentaconnect.com/content/sp/etm/2020/00000019/00000004/art00034
[18]	CHEN Q, SUN G B, WANG Y Y, et al. The evaluation of two new hyaluronan hydrogels as nasal dressing in the rabbit maxillary sinus[J]. Am J Rhinol Allergy, 2012, 26(2): 152-156. doi: 10.2500/ajra.2012.26.3715
[19]	ZHANG L P, WANG M, SHANG X, et al. The incidence of placenta related disease after the hysteroscopic adhesiolysis in patients with intrauterine adhesions[J]. Taiwan J Obstet Gynecol, 2020, 59(4): 575-579. doi: 10.1016/j.tjog.2020.05.018
[20]	张露平, 赵卫红, 杨保军, 等. 中重度宫腔粘连综合治疗效果[J]. 武警医学, 2017, 28(3): 247-250, 253. doi: 10.3969/j.issn.1004-3594.2017.03.008