易先友 张珊 彭艳丽

[摘要] 目的 探讨几丁糖联合球囊子宫支架预防中重度宫腔粘连分离术后再粘连的临床疗效。 方法 收集2016年6月～2018年6月我院接受宫腔镜检查证实有中重度宫腔粘连并成功分离粘连的患者62例，随机分为研究组和对照组，研究组为几丁糖2 mL+球囊扩张+人工周期治疗，对照组术后放置宫型节育环+人工周期治疗。手术后严密随访患者情况，详细记录疗效情況、月经情况、妊娠情况，并对随访结果进行统计学分析。 结果 （1）研究组和对照组治疗疗效分别为28例（90.32%）、25例（80.65%），差异有统计学意义（P<0.05）。（2）研究组和对照组术后月经改善情况分别为27例（89.10%）、23例（74.19%）、妊娠率分别为6例（51.61%）、9例（29.03%），两组比较差异均有统计学意义（P<0.05）。 结论 中重度宫腔粘连分离术后宫腔注入几丁糖联合球囊子宫支架、人工周期可以明显提高宫腔粘连治疗有效率，降低术后再次粘连的发生，对改善月经及促进生育有积极意义，值得在临床推广使用。

[关键词] 几丁糖;宫腔粘连;球囊子宫支架;宫腔粘连分离术;再粘连;复发;妊娠率

[中图分类号] R713.4          [文献标识码] A          [文章编号] 1673-9701（2020）15-0011-03

Observation of clinical efficacy of chitosan combined with balloon stent in preventing re-adhesion after separation of intrauterine adhesions

YI Xianyou   ZHANG Shan   PENG Yanli   JIANG Qinghua

Department of Gynecology， Zhangjiajie People's Hospital in Hu'nan Province， Zhangjiajie   427000， China

[Abstract] Objective To investigate the clinical efficacy of chitosan combined with balloon stent in preventing re-adhesion after separation of moderate and severe intrauterine adhesions. Methods 62 patients with moderate and severe intrauterine adhesions confirmed by hysteroscopy and successfully separated from the adhesions in our hospital from June 2016 to June 2018 were collected and randomly divided into study group and control group. The study group was treated with chitosan 2 mL+balloon dilatation+artificial cycle， while the control group was treated with intrauterine contraceptive ring+artificial cycle after operation. The patients were closely followed up after the operation， the curative effect， menstruation and pregnancy were recorded in detail， and the follow-up results were statistically analyzed. Results （1）The therapeutic effects of the study group and the control group were respectively 28 cases（90.32%） and 25 cases（80.65%），with statistically significant difference（P<0.05）.（2）The improvement of menstruation in the study group and the control group was respectively 27 cases（89.10%） and 23 cases（74.19%）， and the pregnancy rate was respectively 6 cases（51.61%） and 9 cases（29.03%）. The differences between two groups was statistically significant（P<0.05）. Conclusion Intrauterine infusion of chitosan combined with balloon uterine stent and artificial cycle can significantly improve the effective rate of intrauterine adhesion treatment and reduce the occurrence of postoperative re-adhesion， which is of positive significance for improving menstruation and promoting fertility， and is worthy of clinical promotion and application.

[Key words] Chitosan; Intrauterine adhesion; Balloon uterine stent; Separation of intrauterine adhesions; Re-adhesion; Recurrence; Pregnancy rate

宫腔粘连（Intrauterine adhesion，IUA）是指由于感染創伤等原因引起子宫内膜特别是基底层内膜损伤，导致子宫腔及宫颈部分或全部粘连甚至闭经，出现月经量少、闭经、周期性下腹痛、不孕、流产等严重危害女性身心健康的并发症[1]。近年来，各大文献数据均表示，人工流产、药物流产、引产后清宫、胎盘残留清宫、上环、取环等各种宫腔操作后的月经异常发生率明显升高[2]，导致宫腔粘连的发病率也越来越高，不孕症的发病率日渐上涨，严重影响育龄生育期妇女的生殖健康[3]。宫腔粘连对于无生育要求、仅表现为月经量减少的妇女多采取定期待观察疗法，无症状及生育要求可不予处理，但是对于有生育要求的则需进行积极有效的治疗，目前宫腔镜下宫腔粘连分离……