探讨宫腔镜下宫腔黏连分离术(TCRA)后，预防再次黏连的3种方法的临床效果。

选择2010年1月至2016年1月，于西北妇女儿童医院采用宫腔镜检查被诊断为宫腔黏连(IUA)，并且需收治入院进行TCRA治疗的495例患者为研究对象。采用抽签方法，将495例患者随机分为A、B及C组。对A组患者(n＝180)术后于宫腔内放置支撑球囊联合可吸收防黏连填充隔离材料，B组患者(n＝168)术后于宫腔内仅放置支撑球囊，C组患者(n＝147)术后于宫腔内放置宫内节育器(IUD)，并且3组患者均于TCRA后接受雌孕激素序贯疗法修复子宫内膜。于TCRA后，对患者进行随访，并在第3个月复查时，进行宫腔镜检查，然后根据1988年美国生育协会(AFS)关于宫腔镜检查及患者临床表现对IUA的评分标准及程度判断，对3组患者IUA情况再次进行评分，包括IUA范围、黏连类型、月经情况各项评分及3者的总分，以评价疗效。采用随机对照研究方法，对以下项目进行统计学分析：①对3组患者术前一般情况、AFS对IUA的评分总分，以及各项得分进行比较；②对3组患者术后第3个月随访时的治疗有效率、AFS对IUA的评分总分，以及各项得分进行比较。在本研究实施前，均与患者签署了知情同意书。

①3组IUA患者TCRA前一般情况，包括年龄、人体质量指数(BMI)、人工终止妊娠术/刮宫术次数，术前AFS对IUA的评分总分及IUA范围、黏连类型及月经情况各项得分分别比较，差异均无统计学意义(P>0.05)。②术后第3个月随访时，A组IUA患者的治疗有效率为88.3%(159/180)，高于C组的60.5%(89/147)，并且差异有统计学意义(χ²＝16.000，P<0.001)。③术后第3个月时，A组AFS对IUA的评分中，月经情况得分显著低于C组，并且差异有统计学意义(P<0.001)；其余项目得分，包括IUA范围得分、黏连类型得分，以及AFS对IUA的评分总分比较，A组分别较B、C组低，B组较C组低，并且差异均有统计学意义(P<0.05)。

本研究采取的3种预防再次IUA的方法中，TCRA后宫腔内放置支撑球囊联合可吸收防黏连填充隔离材料，较术后宫腔内仅放置支撑球囊或放置IUD的效果更好。

To compare the curative effects of three methods in the prevention of adhesion reformation after transcervical resection of adhesion (TCRA).

A total of 495 patients were involved, who were diagnosed as intrauterine adhesions (IUA) by hysteroscopy and received TCRA treatment in the Northwest Women and Children′s Hospital from January 2010 to January 2016. The 495 patients were randomly divided into A, B and C 3 groups by drawing lots. There were 180 IUA patients in group A, who were placed foley catheter ballon combined with absorbable anti-adhesion materials in uterine cavity to prevent adhesion reformation after TCRA. There were 168 IUA patients in group B, who were only placed foley catheter ballon in uterine cavity after TCRA. And there were 147 IUA patients in group C, who were placed intra-uterine device (IUD) in uterine cavity after TCRA. Meanwhile, three groups of patients were treated with estrogen-progestogen sequential therapy to repair endometrium. All patients were followed up after TCRA, and hysteroscopic examination was conducted at the third month after TCRA. Then according to IUA score criteria and the judgment of degree based on the 1988 American Society for Fertility (AFS) on hysteroscopic examination and clinical manifestations of patients with IUA, the IUA situation which included the total scores and the scores of scope of IUA, type of adhesions and menstrual status of three groups of patients, were evaluated again to evaluate efficacy of each method. The following items were statistically compared by the randomized controlled clinical trial: the general situation of patients, the IUA score by AFS and each item′s score before TCRA among three groups were compared. The effective rate, IUA score by AFS and each item′s score at the third month after TCRA among three groups were compared. Informed consent was signed with each patient before this study was implemented.

①According to the data collected before TCRA, there were no significant differences among three groups in the general situation of patients′s age, body mass index (BMI), the frequency of artificial termination of pregnancy or curettage, the IUA score by AFS and the each item′s score of scope of IUA, the type of adhesions and menstruation status (P>0.05). ②At the third month after TCRA, the effective rate of group A (88.3%, 159/180) was higher than that of group C(60.5%, 89/147), and the difference was statistically significant (χ²=16.000, P<0.001). ③At the third month after TCRA, the menstruation status score of group A was significantly lower than that of group C, and the difference was statistically significant (P<0.001). The scores of IUA scope, adhesions type and IUA score by AFS of group A were lower than those of group B and C, respectively; similarly, those of group B was lower than those of group C, and all the differences were statistically significant (P<0.05).

Among these three methods in the prevention of adhesion reformation after TCRA, the placement of the foley catheter ballon combined with absorbable anti-adhesion materials in uterine cavity has better curative effect than the placement of foley catheter ballon or IUD in uterine cavity.