本文選題：宮腔粘連 + 幾丁糖　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：宮腔粘連(intrauterine adhesion，IUA)又稱asherman綜合征，是子宮內(nèi)膜受損后修復過程中形成瘢痕組織，引起宮腔壁相互粘連，破壞宮腔的正常結(jié)構(gòu)，從而引發(fā)月經(jīng)過少、閉經(jīng)、痛經(jīng)、不孕或反復流產(chǎn)等嚴重后果，嚴重影響患者的生活質(zhì)量。多由宮腔手術(shù)操作、盆腔感染等因素所導致。隨著宮腔鏡技術(shù)的不斷發(fā)展，宮腔鏡手術(shù)治療宮腔粘連已得到廣泛認可及應用。其具有更直觀、微創(chuàng)、恢復快、并發(fā)癥少的優(yōu)點，對治療宮腔粘連臨床療效顯著。但中、重度宮腔粘連術(shù)后復發(fā)率高，臨床治愈率及遠期預后都不理想。本研究意以傳統(tǒng)治療方法做對照，通過分析術(shù)后宮腔粘連復發(fā)率、月經(jīng)恢復有效率、妊娠率三個方面研究綜合治療方法對預防術(shù)后宮腔粘連的療效。 方法：對邢臺市人民醫(yī)院婦產(chǎn)科2012年9月一2013年10月58例中、重度宮腔粘連患者的臨床資料進行回顧性分析。將2012年9月—2013年3月宮腔粘連患者分為A組，將2013年4月—2013年10月宮腔粘連患者分為B兩組，每組29例。兩組患者的平均年齡、粘連程度的構(gòu)成比等一般情況對比無顯著性差異（p0.05），具有可比性。術(shù)后防粘連的方法分別為放置宮內(nèi)節(jié)育器+戊酸雌二醇、黃體酮人工周期組(A組)和采用宮腔內(nèi)放置氣囊導尿管1周+注入防黏連劑幾丁糖+放置宮內(nèi)節(jié)育環(huán)+戊酸雌二醇、黃體酮人工周期組(B組)。有生育要求的患者可于術(shù)后3個月取環(huán)。兩組患者術(shù)后均進行嚴密隨訪，分別于術(shù)后l、3、9個月返院復查，記錄其月經(jīng)恢復及妊娠情況，同時進行宮腔鏡檢查宮腔粘連復發(fā)情況。本研究數(shù)據(jù)使用x2檢驗，P0．05可認為對比效果滿意，有統(tǒng)計學意義。 結(jié)果：①術(shù)后1個月復查結(jié)果為：A組宮腔粘連復發(fā)率51.7%，，月經(jīng)恢復有效率55.2％；B組宮腔粘連復發(fā)率31.0%，月經(jīng)恢復有效率75.9％，B組宮腔粘連復發(fā)率低于A組(P0．05)，月經(jīng)恢復有效率高于A組(P0．05)，兩組比較差異均有統(tǒng)計學意義； ②術(shù)后3個月復查結(jié)果為：A組復發(fā)率可達34.5%，月經(jīng)恢復可達65.5％；B組復發(fā)率可達17.2%，月經(jīng)恢復可達82.8％，B組復發(fā)率低于A組(P0．05)，月經(jīng)恢復有效率高于A組(P0．05)，兩組比較差異均有統(tǒng)計學意義； ③術(shù)后9個月復查結(jié)果為A組復發(fā)率可達24.1%，月經(jīng)恢復可達75.9％，妊娠率可達29.4％；B組復發(fā)率可達10.3%，月經(jīng)恢復可達89.7％，妊娠率可達55.6％，B組復發(fā)率低于A組(P0．05)，月經(jīng)恢復有效率、妊娠率均高于A組(P0．05)，兩組比較差異均有統(tǒng)計學意義。 結(jié)論：本研究中采用術(shù)后于宮腔內(nèi)放置氣囊導尿管1周作為擴張支架，輔以幾丁糖防黏連，1周后放置宮內(nèi)節(jié)育器，配合雌、孕激素人工周期的綜合治療方法預防術(shù)后宮腔再粘連，其術(shù)后宮腔再粘連率明顯低于對照組，月經(jīng)恢復及生殖預后均高于對照組，臨床治療效果滿意，值得臨床推廣。
[Abstract]:Objective: intrauterine adhesion (IUA), also known as Asherman syndrome, is the formation of scar tissue during the repair of endometrium, causing the adhesion of the walls of the uterine cavity and destroying the normal structure of the uterine cavity, thus causing severe consequences such as oligomenstruation, amenorrhea, dysmenorrhea, infertility or repeated abortion, which seriously affect the quality of life of the patients. With the continuous development of hysteroscopic technology, hysteroscopic surgery has been widely recognized and applied in the treatment of intrauterine adhesions with the development of hysteroscopy. It has the advantages of more intuitive, minimally invasive, quick recovery and less complications, and has a significant clinical effect on the treatment of intrauterine adhesions. However, the recurrence rate of severe uterine adhesion is high, and the postoperative recurrence rate is high. The cure rate and the long-term prognosis of the bed were not ideal. This study was compared with the traditional treatment method. By analyzing the recurrence rate of intrauterine adhesions, the effective rate of menstruation recovery and the pregnancy rate, the effect of comprehensive therapy on preventing postoperative intrauterine adhesions was studied in the three aspects.
Methods: the clinical data of 58 patients with severe adhesions in the Department of Obstetrics and Gynecology of Xingtai People's Hospital from September 2012 to October 2013 were analyzed retrospectively. The patients were divided into A group from September 2012 to 2013 3, and the patients were divided into two groups, 29 cases in each group, and the average age of the two groups. There was no significant difference in the composition of the degree of Association (P0.05). The methods of postoperative anti adhesion were intrauterine IUD + estradiol valerate, the group of progesterone (A) and 1 weeks of intrauterine urethral catheterization + intrauterine intrauterine ring + estradiol valerate and yellow valerate by placing the balloon catheter in the uterine cavity. The patients with reproductive requirements (group B). The patients with reproductive requirements could take rings 3 months after the operation. The two groups were followed up closely after the operation and were reexamined at L and 3,9 months after operation. The recovery of menstruation and pregnancy were recorded, and the hysteroscopic examination of the recurrence of intrauterine adhesions was carried out. The data of this study were compared with the x2 test, and P0.05 may be considered as comparison. The effect is satisfactory and there is statistical significance.
Results: 1 months after operation, the results were as follows: the recurrence rate of intrauterine adhesions in the A group was 51.7%, the rate of menstrual recovery was 55.2%, the recurrence rate of uterine adhesion in group B was 31%, the rate of menstrual recovery was 75.9%, and the recurrence rate of uterine cavity adhesion in group B was lower than that in group A (P0.05), and the rate of menstrual recovery was higher than that in group A (P0.05), and the difference was statistically significant in the two groups.
The reexamination results of 3 months after operation were as follows: the recurrence rate of group A was 34.5%, the recovery of menstruation could reach 65.5%, the recurrence rate of group B was 17.2%, menstrual recovery was 82.8%, the recurrence rate of group B was lower than that of group A (P0.05), and the rate of menstrual recovery was higher than that of group A (P0.05), and the difference was statistically significant in the two groups.
(3) 9 months after operation, the reexamination results were 24.1% in group A, 75.9% for menstrual recovery, 29.4% for pregnancy, 10.3% in group B, 89.7% for menstruation, and 55.6% in pregnancy rate. The recurrence rate in group B was lower than that in group A (P0.05), the rate of menstrual recovery was higher than that of group A (P0.05), and there were statistical differences in the comparison of the two groups. Learning meaning.
Conclusion: in this study, the balloon catheter was placed in the uterine cavity for 1 weeks as an expansion stent, supplemented with chitosan and anti stickiness, 1 weeks after the intrauterine device was placed, combined with the synthetic treatment of female and progestin cycles to prevent postoperative uterine adhesion. The readhesion rate of the uterine cavity after operation was significantly lower than that of the control group, the recovery of menstruation and the reproductive prognosis. All of them were higher than those of the control group. The clinical effect was satisfactory and worthy of clinical promotion.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713.4

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