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目的 探讨重度宫腔粘连(intrauterine adhensions,IUA)行宫腔镜下宫腔粘连分解术(transcervical resection of adhensions,TCRA)后预防宫腔再粘连的措施。方法 回顾性分析2007年5月至2010年11月宝鸡市妇幼保健院妇科内镜诊治中心住院治疗的123例患者的临床资料,其粘连程度均经宫腔镜检查确诊为重度宫腔粘连。A组54例,术后宫腔置入“O”型金属宫内节育器(intrauterine contraceptive device,IUD)并注入透明质酸钠2ml;B组69例,术后宫腔置入“O”型金属IUD并注入透明质酸钠2ml且联合明胶海绵填塞宫颈管。两组术后均给予抗生素预防感染和人工周期治疗3月;术后1、3、9个月均门诊宫腔镜复查,观察术后宫腔形态恢复情况及月经改善情况。结果 宫腔再粘连率B组低于A组(P<0.05),月经改善率B组优于A组(P<0.05)。结论 宫腔内放置IUD并注入透明质酸钠且联合填塞明胶海绵条可有效预防宫腔镜电切术后再粘连,提高月经正常率。
Objective To investigate the prevention of intrauterine adhesions after intrauterine adhensions (IUA) undergoing hysteroscopic transcervical resection of adhensions (TCRA). Methods The clinical data of 123 patients hospitalized in gynecological endoscopy center of Baoji Maternal and Child Health Hospital from May 2007 to November 2010 were retrospectively analyzed. The degree of adhesion was diagnosed as severe intrauterine adhesions by hysteroscopy. In group A, 54 cases were treated with “O” intrauterine contraceptive device (IUD) and 2 ml of sodium hyaluronate into the uterine cavity after operation; 69 cases in group B, O "metal IUD and injected with 2ml sodium hyaluronate and gelatin sponge stuffed cervical canal. Antibiotic prophylaxis and artificial cycle treatment were given in both groups after 3 months of operation. Hysteroscopy was performed at 1, 3 and 9 months after operation, and postoperative recovery of uterine morphology and improvement of menstruation were observed. Results The rate of intrauterine reoctenosis in group B was lower than that in group A (P <0.05). The rate of improvement in menstruation in group B was better than that in group A (P <0.05). Conclusion Intrauterine placement of IUD and injection of sodium hyaluronate combined with gelatin sponge packing can effectively prevent hysteroscopic resection and improve the normal rate of menstruation.