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目的探讨宫腔镜下粘连分离术联合宫腔内羊膜移植对复发性重度宫腔粘连的临床疗效。方法选取2016年12月-2017年6月60例复发性重度宫腔粘连患者,分为两组:实验组(30例)宫腔内羊膜移植+放置球囊;对照组(30例)宫腔内放置球囊。所有患者均于术后第1天开始口服补佳乐(6 mg/d,60 d),最后10 d加服黄体酮胶囊(200 mg/d,10 d)。术后1个月复查宫腔镜,取出球囊及宫腔残留的羊膜,评估粘连修复情况。各组中已治愈或明显好转的患者于复查术后第1个自然周期的中晚期行经阴道三维超声检查,比较子宫内膜厚度、宫腔容积、血流指数。结果实验组的治愈率、有效率显著高于对照组[40%(12/30)vs 16.67%(5/30),P=0.045;73.33%(22/30)vs 46.67%(14/30),P=0.035]。实验组的平均内膜厚度、宫腔容积、血流指数等指标明显优于对照组[(8.36±0.77)mm vs(7.21±0.39)mm,P=0.002;(4.37±0.37)cm3 vs(3.90±0.26)cm3,P=0.029;(27.73±0.48)vs(24.30±0.46),P=0.001]。实验组的月经改善率为83.33%,对照组为60.00%,差异有统计学意义(P=0.045)。结论宫腔镜下粘连分离术后宫内放置新鲜羊膜包裹的球囊对复发性重度宫腔粘连具有良好的治疗效果和预防粘连复发的作用。
Objective To investigate the clinical effect of hysteroscopic adhesion separation combined with intrauterine amniotic membrane transplantation on recurrent severe intrauterine adhesions. Methods Sixty patients with recurrent severe intrauterine adhesions from December 2016 to June 2017 were divided into two groups: experimental group (30 cases) intrauterine amniotic membrane transplantation + balloon placement; control group (30 cases) intrauterine cavity Place the balloon inside. All patients received oral nadrogox (6 mg / d, 60 d) on the first postoperative day and progesterone capsules (200 mg / d, 10 d) for the final 10 days. Hysteroscopy was performed 1 month after surgery, and the residual amniotic membrane in the balloon and uterine cavity was removed to evaluate the adhesion repair. Patients in each group, who had been cured or were significantly improved, underwent transvaginal three-dimensional ultrasonography in the first and second trimester of the postoperative period. Endometrial thickness, intrauterine volume, and blood flow index were compared. Results The cure rate and the effective rate in the experimental group were significantly higher than those in the control group [40% (12/30) vs 16.67% (5/30), P = 0.045; 73.33% (22/30) vs 46.67% (14/30) , P = 0.035]. The average intima thickness, intrauterine volume and blood flow index in the experimental group were significantly better than those in the control group [(8.36 ± 0.77) mm vs (7.21 ± 0.39) mm, P = 0.002; (4.37 ± 0.37) cm3 vs ± 0.26) cm 3, P = 0.029; (27.73 ± 0.48) vs (24.30 ± 0.46), P = 0.001]. The improvement rate of menstruation was 83.33% in the experimental group and 60.00% in the control group, the difference was statistically significant (P = 0.045). Conclusion hysteroscopic adhesions after intrauterine placement of fresh amniotic membrane wrapped balloon on the recurrence of severe intrauterine adhesions has a good therapeutic effect and prevention of adhesion recurrence.