几丁糖配合球囊导尿管在宫腔镜剪刀分离术后预防再次黏连的效果分析

摘要

目的 探讨在宫腔镜下行宫腔黏连剪刀分离术后使用几丁糖配合球囊导尿管来预防术后再黏连的价值.方法 2008年10月-2010年3月,53例在本院通过宫腔镜诊断为中度宫腔黏连的患者均在B 超监测下经宫腔镜行剪刀分离术,术后宫腔持续放置球囊导尿管,球囊充水3～5 ml,充水量以患者能耐受为宜,同时宫腔内注入医用几丁糖凝胶(上海其胜生物制剂有限公司)3 ml,导尿管持续开放7 d,术后第2天起口服戊酸雌二醇(补佳乐),2次/d,3 mg/次,共3个月,若阴道流血较月经量多停用5 d后继续服用.结果 53例中度宫腔黏连患者术后随访6月,术后第3个月月经恢复正常37例(69.8%),月经少但较前增多14例(26.4%),经量明显多于平素经量1例(1.9%),仍闭经或月经少且较前无增多1例(1.9%);宫腔形态恢复正常45例(84.9%),基本恢复正常7例(13.2%),术后宫腔再次黏连1例(1.9%).结论 宫腔镜剪刀分离术后宫腔持续放置球囊导尿管并辅以几丁糖和戊酸雌二醇综合治疗来预防术后宫腔黏连复发是安全、有效的方法.%Objective To discuss the re - adhesion preventing value of chitosan combined with saccule urinary catheter after the separation of hysteroscopy scissors dissection.Methods 53 cases of moderate intrauterine adhesions confirmed by hysteroscopy underwent hysteroscopy scissors dissection during October 2008 to March 2010 in the Second worker's Hospital of WISCO.After the separation of hysteroscopy scissors dissection, the saccule urinary catheter was continually put into the Uterine and was filled with 3 - 5 ml water, which was appropriate to the patient's toleration.At the same time, 3 ml of chitosan made by Shanghai Qisheng Biological Preparation Co., LTD was injected into the uterine.The catheter remained open for 7 days, and in the second day after the hysteroscopy scissors dissection, the progynova was taken 2 times a day and 3mg each time for a total 3 months.If the amount of vaginal bleeding was more than the amount of menstrual, the progynova should stop for five days before using it again.Results According to 6 months follow - up observation of the 53 cases of moderate IUA patients, 37 cases ( 69.8％ ) resumed normal menstrual flow after 3 months; 14 cases ( 26.4％ ) had a little menstrual flow but it was increased than before; 1 case ( 1.9％ ) had significantly more menstrual flow than usual and 1 case was still menorrheal; 45 cases ( 84.9％ ) recovered normal uterine morphology; 7 cases ( 13.2％ ) returned to normal; there was still a re - adhesions case ( 1.9％ ).Conclusion The integrated approach to prevent postoperative recurrence of intrauterine adhesions after hysteroscopy scissors dissection by using the saccule urinary catheter supplemented with chitosan and progynova is safe and effective.