HEOS冷刀宫腔镜系统与传统宫腔镜治疗中重度宫腔粘连的效果比较

熊春秋 徐英军 赵静静 杜洁冰 白华 夏苏桦

【摘要】 目的 观察宫腔镜冷刀切除治疗中重度宫腔粘连（intrauterine adhesion，IUA）的临床疗效。

方法 选取广西壮族自治区妇幼保健院收治的120例中重度IUA患者，随机分为两组，各60例，观察组予以HEOS宫腔镜冷刀切除术，对照组予以传统宫腔镜电切术，比较两组手术时间、术中出血量、术后宫腔形态恢复、手术次数、月经恢复及并发症发生率。

结果 对照组手术时间明显短于观察组（P<0.05），观察组术中出血量与手术次数明显少于对照组（P<0.05或0.01）;观察组术后宫腔形态、月经恢复效果明显优于对照组（P<0.05）;两组子宫穿孔、水中毒等并发症比较差异无统计学意义（P>0.05）。

結论 相较于传统宫腔镜电切术，HEOS宫腔镜冷刀切除术治疗中重度IUA具有出血量少，术后宫腔形态及月经恢复快的优势，同时可减少再次手术次数。

【关键词】 宫腔镜;冷刀切除;电切术;中重度宫腔粘连

中图分类号：R713.4   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.10.002

Comparison of therapeutic effects of HEOS cold knife hysteroscopy system and traditional hysteroscopy in the treatment of moderate and severe uterine adhesion

XIONG Chunqiu， XU Yingjun， ZHAO Jingjing， DU Jiebing， BAI Hua▲， XIA Suhua

（Department of Gynecology， Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region， Nanning 530003， Guangxi， China）

【Abstract】 Objective To observe the clinical effect of hysteroscopic cold knife resection in the treatment of moderate and severe intrauterine adhesion （IUA）.

Methods 120 cases of moderate and severe IUA were selected and randomly divided into two groups， with 60 cases in each group. Observation group were treated with HEOS hysteroscopic cold knife resection and control group with traditional hysteroscopic electrotomy. And then， operation time， intraoperative bleeding volume， postoperative uterine morphology recovery， operation times， menstrual recovery and the incidence of complications were compared between the two groups.

Results The operation time of the control group was significantly shorter than that of the observation group （P < 0.05）. The amount of intraoperative bleeding and the times of operation in the observation group were significantly less than those in the control group （P < 0.05 or 0.01）. The recovery effects of uterine cavity morphology and menstruation in the observation group were significantly better than those in the control group （P < 0.05）. There was no statistically significant difference in complications such as uterine perforation and water poisoning between the two groups （P > 0.05）.

Conclusion Compared with traditional hysteroscopic electroresection， HEOS hysteroscopic cold knife resection has the advantages of less bleeding， rapid postoperative uterine morphology and menstrual recovery， and can reduce the times of reoperation.

【Key words】 hysteroscopy; cold knife resection; electrotomy; moderate and severe uterine adhesion

宫腔粘连（intrauterine adhesion，IUA）亦有Asherman综合征之称，主要指妊娠或非妊娠引起的子宫创伤，影响到子宫内膜基底层，最终出现内膜纤维化以及宫腔粘连变性[1～2]。IUA患者会产生月经改变（经量减少或者闭经）、腹痛、反复性流产、胎盘植入、不孕等临床表现，严重威胁其生殖健康[3～4]。宫腔镜下分离术为当前IUA手术金标准，较为常用的术式包括宫腔镜下电切术以及冷刀切除术。以往报道称，宫腔镜冷刀切除技术仅通过机械分离，可以降低对邻近组织电热损伤，尽可能保护患者正常子宫内膜，降低瘢痕修复率，有效避免热辐射造成的脏器损伤[5]。本文以120例中重度IUA患者为研究对象，探讨宫腔镜冷刀切除治疗中重度IUA的效果，以期为中重度IUA更有效治疗方案的选择提供一定理论依据，现汇报如下。……