目的 比较COOK球囊和防粘连膜包裹宫内节育器(intrauterine device,IUD)及羊膜包裹COOK球囊三种方法预防中重度宫腔粘连(intrauterine adhesion ,IUA)术后再粘连的近期及远期临床效果。方法 选取2015-12至2020-02在武警广东总队医院妇产科行IUA手术患者109例,根据宫腔镜IUA分离术后采用防粘连方法分为3组,A组放置COOK球囊,B组放置防粘连膜包裹金属圆环,C组放置羊膜包裹COOK球囊,3组术后均给予人工周期治疗补佳乐4 mg/d,共21 d,第10 天加用地屈孕酮20 mg/d,术后第1次月经干净3～7 d行宫腔镜二次探查。A组患者术后1个月宫腔镜检查同时取出COOK球囊,B组则取出IUD,C组术后进行宫腔镜检查,记录并比较3组患者宫腔恢复及月经恢复情况,比较3组患者术后1个月及术后3个月宫腔再粘连情况,比较3组术后并发症发生情况及术后1年的妊娠率。术后3个月对3组复查超声提示IUA,且月经量明显减少者再次行宫腔镜探查。结果 3组IUA术后1个月宫腔形态恢复总有效率及月经改善基本一致,差异无统计学意义。3个月后宫腔镜检查,A组、C组宫腔再粘连发生率明显低于B组,差异有统计学意义(P<0.05)。术后1年妊娠率3组基本一致,差异无统计学意义。术后B组发生IUD嵌顿19例,发生腰酸腹痛10例,不规则阴道出血7例。A、C组并发症明显少于B组,差异有统计学意义(P<0.05)。结论 三种方法术后近期防再粘连的效果基本一致,但IUD并发症发生率高,术后远期防宫腔粘连效果较差, COOK球囊和放置羊膜防粘连更适用于临床应用。

Objective To compare the short-term and long-term clinical effects of the COOK balloon, the intrauterine device (IUD) coated with anti-adhesion membrane and the COOK balloon coated with amniotic membrane against postoperative moderate to severe intrauterine adhesions (IUA).Methods One hundred and nine patients undergoing uterine adhesion surgery at the Department of Obstetrics and Gynecology of Guangdong Provincial Armed Police Headquarters Hospital between December 2015 and February 2020 were selected. According to the methods of preventing postoperative adhesions following hysteroscopy of IUA, these patients were divided into three groups. The COOK balloon was used in group A, the metal ring coated with anti-adhesion membrane in group B, while the COOK balloon coated with amniotic membrane in group C. The three groups were given artificial cycle therapy with Progynova 4 mg/d for a total of 21 d. Progesterone 10 mg/d was added from the tenth day. Hysteroscopy was performed a second time 3 to 7 d after the end of the first menstruation post-operatively. One month after operation, the COOK balloon was removed in group A, IUDs in group B, while hysteroscopy was performed in group C. The recovery of the uterine cavity and menstruation was observed and compared. Intrauterine adhesions one month and three months after operation was compared between the three groups. Post-operative complications and the pregnancy rate one year after operation were also compared between the three groups. Three months after operation, patients whose ultrasound showed intrauterine adhesions and menstrual volume was significantly reduced were r-examined with hysteroscopy.Results The total effective rate of the recovery of the uterine cavity morphology was similar across the three groups. Three months later, the incidence of intrauterine adhesions in group A and group C was significantly lower than in group B (P<0.05). There was no significant difference in the pregnancy rate between the three groups (P<0.01). However, there were 2 cases of abdominal pain and irregular vaginal bleeding in group A, 19 cases of incarceration of IUDs, 10 cases of low back pain and 7 cases of irregular vaginal in bleeding group B. After IUDs were removed, the symptoms were relieved.Conclusions The short-term effect of the three approaches to prevention of post-operative intrauterine adhesions is similar, but IUDs are likely to cause complications, and are not quite effective for long-term postoperative prevention of intrauterine adhesions. The COOK balloon and amniotic membrane are clinically more applicable.