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目的:探讨新鲜羊膜移植对中、重度宫腔粘连患者行宫腔镜宫腔粘连分离术(transcervical resection of adhesions,TCRA)后月经模式的影响。方法:选择2015年1至12月于我院宫腔镜检查确诊的46例表现为月经过少或闭经的中重度宫腔粘连患者,分为羊膜移植组(24例)和几丁糖组(22例)。羊膜移植组在TCRA术后行新鲜羊膜移植,几丁糖组在TCRA术后宫内注射几丁糖。术后1、3个月行B超及宫腔镜检查,随访观察子宫内膜厚度及月经改善情况。结果:所有患者手术过程均顺利且无相关并发症。羊膜移植组和几丁糖组患者月经完全或显著改善分别为87.5%(21/24)、50%(11/22);羊膜移植组总有效率为100%(24/24),几丁糖组总有效率为81.8%(18/22)。经统计分析,羊膜移植组子宫内膜厚度和月经持续时间优于几丁糖组,差异具有统计学意义(P1=0.002,P2=0.025);但2组月经改善总有效率比较,差异无统计学意义(P=0.096)。结论:TCRA术后将新鲜羊膜移植入宫腔能在一定程度上优化宫腔粘连患者月经情况,为宫腔粘连患者提高生育率提供了新的希冀。
Objective: To investigate the effect of fresh amniotic membrane transplantation on menstrual patterns after hysteroscopic transcervical resection of adhesions (TCRA) in patients with moderate or severe adhesions. Methods: Forty-six patients diagnosed as hysteroscopic or amenorrheic uterine adhesions from January to December in 2015 were divided into amnion transplantation group (n = 24) and chitosan group (n = 22 cases). Amniotic membrane transplantation group underwent fresh amniotic membrane transplantation after TCRA, chitosan group intrauterine injection of chitosan after TCRA. B and Hysteroscopy were performed at 1 and 3 months after operation. The thickness of endometrium and the improvement of menstruation were observed. Results: All patients underwent surgical procedures without any complications. Amniotic membrane transplantation group and chitosan group patients with complete or significant improvement of menstruation were 87.5% (21/24), 50% (11/22); amniotic membrane transplantation group, the total effective rate was 100% (24/24), chitosan The total effective rate was 81.8% (18/22). The statistical analysis showed that the amniotic membrane transplantation group was superior to chitosan group in endometrial thickness and duration of menstruation (P <0.001, P <0.05), but there was no statistical difference between the two groups in the total effective rate of menstruation Significance (P = 0.096). Conclusion: Transplantation of fresh amnion into the uterine cavity after TCRA can optimize the menstrual status of patients with intrauterine adhesions to a certain extent, which provides new hope for the improvement of fertility in patients with intrauterine adhesions.