A Comparative Study of Three Methods of Preventing Intrauterine Adhesions after HEOS
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摘要:
目的 比较3种不同方法在HEOS系统治疗不同程度宫腔粘连术后预防再粘连疗效的研究。 方法 分析昆明市妇幼保健院收治的284例的轻中重度宫腔粘连患者,使用HEOS系统治疗后,分为3组,A组(节育环组)放置宫内节育环+透明质酸钠凝胶、B组(球囊组)放置Foley水囊管+透明质酸钠凝胶、C组(对照组)仅放置透明质酸钠凝胶。比较3组术后宫腔粘连恢复情况、月经改善情况、子宫内膜厚度以及术后不良反应。 结果 轻度宫腔粘连组,月经改善情况中3组比较,差异有统计学意义(P<0.05),A组比C组月经改善率高(对R×C卡方检验两两比较,校正显著水平,P<0.017),其他疗效指标中无显著差异(P>0.017),但A组不良反应率较C组高(P<0.017)。在中度宫腔粘连组,B组的宫腔粘连改善率与其他两组比较有显著差异(P<0.017)。在月经改善率、子宫内膜厚度、不良反应方面,A、B组均较C组增加(P<0.017)。重度宫腔粘连组中,A组各疗效指标均较其他组高(P<0.017)。 结论 综合疗效指标和不良反应率分析,对轻、中、重度宫腔粘连,术后依次为放置透明质酸钠凝胶、Foley水囊管+透明质酸钠凝胶、宫内节育环+透明质酸钠凝胶为各程度粘连的最佳选择。达到个体化及分层管理,可取得良好临床效果,值得推广。 Abstract:Objective To compare the efficacy of three different methods in the prevention of adhesion after the HEOS system for different degrees of intrauterine adhesions. Methods 284 patients with mild, moderate and severe intrauterine adhesions, who were treated with the HEOS system, were divided into three groups, the intrauterine device with sodium hyaluronate gel was placed in Group A, Foley water capsule tube with sodium hyaluronate gel was placed in Group B, and sodium hyaluronate gel was placed in Group C only. The recovery of uterine adhesion, improvement of menstruation, endometrial thickness, and adverse reactions were compared among the three groups. Results The mild intrauterine adhesions group showed statistical differences among the three groups(P<0.05). Group A had a higher menstrual improvement rate than Group C(P<0.017), and there was no significant difference in other therapeutic indicators(P>0.017). However, the adverse reaction rate in Group A was also higher than that in Group C(P<0.017). In the moderate intrauterine group, there was a significant difference in the improvement rate of intrauterine adhesions between Group B and the other two groups(P<0.017).Group A and B were higher than Group C in terms of menstrual status, endometrial thickness, and adverse reactions(P<0.017). In severe intrauterine adhesions, Group A had higher efficacy indicators than other groups(P<0.017). Conclusions The curative effect index and adverse reaction rate were analyzed, after operation. For the light, moderate, and severe intrauterine adhesions, sodium hyaluronate gel, Foley water capsule tube with sodium hyaluronate gel, and intrauterine device with sodium hyaluronate gel were the best choice for adhesion. Individual and hierarchical management can achieve good clinical effects, which is worth popularizing. -
Key words:
- Intrauterine adhesion /
- HEOS system /
- Intrauter inedevice /
- Foley water bag tube
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表 1 轻度宫腔粘术后2个月疗效评价及不良反应情况比较 [n(%)]
Table 1. Evaluation of curative effect and comparison of adverse reactions after 2 months of mild intrauterine adhesion surgery [n(%)]
组别 n 宫腔形态恢复 月经情况 子宫内膜厚度(≥7 mm) 不良反应 有效 无效 有效 无效 有效 无效 有 无 节育环组 31 28(90.3) 3(9.7) 26(83.9) 5(16.1) 28(90.3) 3(9.7) 8(25.8) 23(74.2) 球囊组 30 26(86.7) 4(13.3) 17(56.7) 13(43.3) 24(80.0) 6(20.0) 4(13.3) 26(86.7) 对照组 32 27(84.4) 5(15.6) 16(50.0) 16(50.0) 22(68.8) 10(31.2) 1(3.1) 31(96.9) P 0.864 0.013* 0.095 0.031* P1 0.020 0.184 P2 0.004** 0.012** P3 0.599 0.158 3组比较,*P<0.05; 节育环组与球囊组比较,**P1 <0.017;节育环组与对照组比较,**P2 <0.017;球囊组与对照组比较,**P3 <0.017。 表 2 中度宫腔粘术后2个月疗效评价及不良反应情况比较[n(%)]
Table 2. Evaluation of Curative Effect and Comparison of Adverse Reactions after 2 Months of Moderate Intrauterine Adhesion Surgery[n(%)]
组别 n 宫腔形态恢复 月经情况 子宫内膜厚度(≥7 mm) 不良反应 有效 无效 有效 无效 有效 无效 有 无 节育环组 33 18(54.5) 15(45.5) 26(78.8) 7(21.2) 25(75.8) 8(24.2) 11(33.3) 22(66.7) 球囊组 32 27(84.4) 5(15.6) 24(75.0) 8(25.0) 27(84.4) 5(15.6) 9(28.1) 23(71.9) 对照组 35 16(45.7) 19(54.3) 17(48.6) 18(51.4) 15(42.9) 20(57.1) 2(5.7) 33(94.3) P 0.003* 0.015* 0.001* 0.009* P1 0.009** 0.717 0.385 0.789 P2 0.467 0.010** 0.006** 0.004** P3 0.001** 0.027 0.001** 0.015** 3组比较,*P<0.05; 节育环组与球囊组比较,**P1 <0.017;节育环组与对照组比较,**P2 <0.017;球囊组与对照组比较,**P3 <0.017。 表 3 重度宫腔粘术后2个月疗效评价及不良反应情况比较[n(%)]
Table 3. Evaluation of curative effect and comparison of adverse reactions after 2 months of severe intrauterine adhesion surgery [n(%)]
组别 n 宫腔形态恢复 月经情况 子宫内膜厚度(≥7 mm) 不良反应 有效 无效 有效 无效 有效 无效 有 无 节育环组 30 19(63.3) 11(36.7) 21(70.0) 9(30.0) 22(73.3) 8(26.7) 13(43.3) 17(56.7) 球囊组 30 9(30.0) 21(70.0) 10(33.3) 20(66.7) 13(43.3) 17(56.7) 15(50.0) 15(50.0) 对照组 31 8(25.8) 23(74.2) 9(29.0) 22(71.0) 11(35.5) 20(64.5) 5(16.1) 26(83.9) P 0.005* 0.002* 0.008* 0.014* P1 0.010** 0.004** 0.018 0.605 P2 0.003** 0.001** 0.003** 0.020 P3 0.715 0.717 0.530 0.005** 3组比较:* P<0.05,节育环组与球囊组比较,**P1 <0.017,节育环组与对照组比较,**P2 <0.017,球囊组与对照组比较,**P3 <0.017。 -
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