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目的探讨透明质酸联合置环对宫腔镜下重度宫腔粘连(IUA)分离术后再次粘连的预防作用。方法将行IUA分离术的120例重度IUA患者随机分为研究组60例和对照组60例,两组患者均常规行IUA分离术;对照组置入气囊+置环,研究组在对照组基础上注入透明质酸;术后3个月进行评价,比较两组患者疗效、再次粘连率、月经改善率和妊娠率,并对两组患者治疗前后子宫内膜厚度进行评价。结果研究组术后3个月检查宫腔无明显粘连,对照组节育器间隙中仍有部分粘连;研究组总有效率为98.33%,显著高于对照组(86.67%),差异具有统计学意义(χ2=9.698,P<0.05);术后3个月研究组月经改善率为90.00%,显著高于对照组(78.33%),差异具有统计学意义(P<0.05);术后6个月研究组妊娠率为48.33%,对照组为33.33%,研究组妊娠率亦显著高于对照组,差异有统计学意义(P<0.05);术后3个月两组患者子宫内膜均明显增厚,与治疗前相比差异具有统计学意义(P<0.05);两组治疗后子宫内膜厚度相比差异无统计学意义(P>0.05)。结论透明质酸联合置环能够有效预防重度IUA分离术后再次粘连,提高妊娠率和月经改善率,值得临床推广应用。
Objective To investigate the preventive effect of hyaluronic acid combined with cyclisation on the re-adhesion after hysteroscopic severe intrauterine adhesions (IUA). Methods One hundred and twenty patients with severe IUA who underwent IUA separation were randomly divided into study group (60 cases) and control group (60 cases) .IUA separation was performed in both groups. The control group was placed in balloon + Hyaluronic acid was injected into the wounds. After 3 months, the curative effect, re-adhesion rate, menses improvement rate and pregnancy rate were compared between the two groups. The thickness of endometrium was evaluated before and after treatment. Results There was no obvious intrauterine adhesions in the study group at 3 months after operation, and there were still some adhesions in the control group. The total effective rate was 98.33% in the study group, which was significantly higher than that in the control group (86.67%), with statistical significance (χ2 = 9.698, P <0.05). The improvement rate of menstruation in study group was 90.00% at 3 months after operation, which was significantly higher than that in control group (78.33%), the difference was statistically significant (P <0.05) The pregnancy rate was 48.33% in the study group and 33.33% in the control group, and the pregnancy rate in the study group was also significantly higher than that in the control group (P <0.05). The endometrium was significantly increased in both groups at 3 months (P <0.05). There was no significant difference in endometrial thickness between the two groups after treatment (P> 0.05). Conclusion Hyaluronic acid combined with ring can effectively prevent re-adhesions after severe IUA separation, improve pregnancy rate and improve the rate of menstruation, which is worthy of clinical application.