宫腔镜下宫腔粘连分离术后C...预防宫腔再次粘连的临床效果_黄婉芬.pdf

422022 Vol.9 No.11Electronic Journal of Practical Gynecological Endocrinology论 著宫腔镜下宫腔粘连分离术后COOK球囊联合雌孕激素预防宫腔再次粘连的临床效果黄婉芬（广东省佛山市顺德区第三人民医院 妇产科，广东 佛山 528311）【摘要】目的 探究宫腔镜下宫腔粘连（IUA）分离术后COOK球囊联合雌孕激素预防宫腔再次粘连的临床效果。方法 选取于本院行宫腔镜下IUA分离术的患者30例为研究对象，根据随机数字表法分为两组，每组15例。单一组术后采用常规雌孕激素治疗，联合组术后采用COOK球囊联合雌孕激素治疗。比较两组的IUA评分、子宫动脉血流水平、月经评分、不良反应发生情况、子宫内膜厚度及满意度等。结果 术前，两组的IUA评分、血流阻力指数、动脉搏动指数比较，差异无统计学意义（P0.05）；术后1、3个月，两组的上述各项指标水平均改善，且联合组IUA评分、血流阻力指数、动脉搏动指数均低于单一组，差异有统计学意义（P0.05）。术前，两组的月经评分比较，差异无统计学意义（P0.05）；术后1、3个月，两组的月经评分均提高，且联合组的（1.150.33）、（0.950.14）分均低于单一组的（1.740.41）、（1.420.35）分，差异有统计学意义（P0.05）。术前，两组的子宫内膜厚度比较，差异无统计学意义（P0.05）；术后1、3个月，两组的子宫内膜厚度均增加，且联合组的（5.490.34）、（6.870.22）mm均高于单一组的（4.080.47）、（5.510.32）mm，差异有统计学意义（P0.05）。两组的不良反应发生率比较，差异无统计学意义（P0.05）。联合组的总满意度为100%，高于单一组的73.33%，差异有统计学意义（P0.05）。结论 宫腔镜下IUA分离术后患者采用COOK球囊联合雌孕激素治疗，可明显改善宫腔再次粘连的情况，患者月经水平恢复，子宫内膜厚度明显增长，子宫动脉血流指标逐渐恢复正常，具有较高的安全性，值得临床推广使用。【关键词】宫腔镜下宫腔粘连分离术；COOK球囊；雌孕激素；宫腔再次粘连Clinical effect of COOK balloon combined with estrogen and progesterone on prevention of intrauterine adhesion after hysteroscopic separation of intrauterine adhesion(IUA)Huang Wanfen(Department of Obstetrics and Gynecology,The Third Peoples Hospital of Shunde District,Foshan City,Guangdong Province,Foshan 528311,China)【Abstract】Objective To study the clinical effect of COOK balloon combined with estrogen and progesterone on preventing intrauterine adhesion after hysteroscopic separation of intrauterine adhesion(IUA).Methods 30 patients who underwent hysteroscopic IUA separation in our hospital were selected as the research objects and divided into two groups according to the random number table method,with 15 cases in each group.The single group was treated with conventional estrogen and progesterone,and the combined group was treated with COOK balloon combined with estrogen and progesterone.The IUA score,uterine artery blood flow level,menstrual score,adverse reactions,endometrial thickness and satisfaction were compared between the two groups.Results Before operation,there were no significant differences in IUA score,blood flow resistance index and arterial pulse index between the two groups(P0.05);at 1 and 3 months after operation,the levels of the above indexes in the two groups were improved,and the IUA score,blood flow resistance index and arterial pulse index in the combined group were lower than those in the single group,and the differences were statistically significant(P0.05).Before operation,there was no significant difference in menstrual scores between the two groups(P0.05);at 1 and 3 months after operation,the menstrual scores of the two groups were improved,and the scores of the combined group were(1.150.33)and(0.950.14)points,lower than(1.740.41)、(1.420.35)points of the single group,and the differences were statistically significant(P0.05).Before operation,DOI：10.3969/j.issn.2095-8803.2022.11.012通信作者：黄婉芬，E-mail：432022 年第 9 卷第 11 期实用妇科内分泌电子杂志论 著there was no significant difference in endometrial thickness between the two groups(P0.05);at 1 and 3 months after operation,the endometrial thickness of the two groups increased,and the thickness of the combined group were(5.490.34)and(6.870.22)mm,higher than(4.080.47)、(5.510.32)mm of the single group,and the differences were statistically significant(P0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P0.05).The total satisfaction of the combined group was 100%,higher than that of the single group(73.33%),and the difference was statistically significant(P0.05).Conclusions COOK balloon combined with estrogen and progesterone in the treatment of patients after IUA separation by hysteroscopy can significantly improve the uterine cavity adhesion,recover menstrual level,increase endometrial thickness,and gradually return to normal uterine artery blood flow indicators,which has high safety and is worthy of clinical application.【Key words】Hysteroscopic separation of intrauterine adhesions;COOK balloon;estrogen and progesterone;Re adhesion of uterine cavity宫腔粘连（IUA）是一种较为常见的妇科疾病。当患者子宫内膜受到破坏时，即有较高风险出现IUA。此外，IUA还与妊娠密切相关，超过90%的IUA患者均与妊娠有一定关联，如接受人工流产手术、刮宫术及产后出血刮宫术等。现阶段，临床主要通过手术对IUA进行分离，但患者在术后有较高的复发几率1，这就需要在术后给予其有效的预防干预。当前临床主要采用药物预防宫腔再次粘连，但整体效果欠理想。COOK球囊联合雌孕激素能够有效改善患者的宫腔情况，帮助其迅速恢复子宫功能，对于宫腔再次粘连的预防具有十分重要的作用。基于此，本研究选取于本院行宫腔镜下IUA分离术的患者30例为研究对象，探究宫腔镜下IUA分离术后COOK球囊联合雌孕激素预防宫腔再次粘连的效果。现报道如下。1 资料与方法1.1 临床资料选取2018年4月至2021年4月于本院行宫腔镜下IUA分离术的患者30例为研究对象，根据随机数字表法分为两组，每组15例。两组患者的各项一般资料比较，差异无统计学意义（P0.05），具有可比性。见表1。表1 两组患者一般资料分析（n，xs）组别例数月经状况平均年龄（岁）孕次（次）产次（次）粘连程度闭经减少中度重度对照组1551035.075.212.140.351.580.3469研究组1541134.585.082.280.411.610.51782/t0.1580.2611.0060.1900.136P0.6900.7960.3230.8510.713纳入标准：符合宫腔粘连临床诊疗中国专家共识2中的相关诊断标准；具有良好的依从性。排除标准：合并有其他慢性疾病者；合并心、肝、肾等器官衰竭者；合并有其他恶性肿瘤者；不同意加入本研究者3。本研究经医院医学伦理委员会批准。1.2 方法单一组采用常规雌孕激素治疗。给予患者戊酸雌二醇片（拜耳医药保健有限公司广州分公司，国药准字J20171038，规格：1 mg）口服，每天1次，每次2 mg，服用11 d。给予患者雌二醇地屈孕酮片（Abbott Biologicals B.V.，注册证号H20150346，规格：每片含雌二醇1 mg和地屈孕酮10 mg）口服，每天1次，每次1片，服用10 d。联合组采用COOK球囊联合雌孕激素。COOK球囊：在术后为患者置入COOK球囊，球囊内注入生理盐水，7 d后放出盐