宫腔镜下冷刀分离术与电切术治疗宫腔粘连的疗效及对宫腔形态恢复和血清白细胞介素的影响

摘要 目的：对比宫腔镜下冷刀分离术与电切术治疗宫腔粘连（IUA）的疗效及对宫腔形态恢复和血清白细胞介素的影响。方法：回顾性分析2019年4月~2021年2月期间来我院接受治疗的83例IUA患者的临床资料。根据手术方式的不同将患者分为A组（宫腔镜下电切术，40例）和B组（宫腔镜下冷刀分离术，43例），对比两组手术时间及住院时间、宫腔形态恢复情况和血清白细胞介素变化，观察两组术后并发症发生率、月经改善率和宫腔再粘连发生率。结果：B组手术时间、住院时间短于A组（P<0.05）。B组总有效率、内膜创面上皮化愈合满意率均高于A组（P<0.05）。两组血清白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平升高，但B组低于A组（P<0.05）。两组血清白细胞介素-4（IL-4）、白细胞介素-10（IL-10）降低，但B组高于A组（P<0.05）。两组术后并发症发生率组间对比无统计学差异（P>0.05）。B组月经改善率高于A组，宫腔再粘连发生率低于A组（P<0.05）。结论：与宫腔镜下电切术治疗IUA相比，宫腔镜下冷刀分离术治疗IUA手术时间、住院时间更短，宫腔形态恢复和月经改善情况更好，机体炎性反应更轻微，同时宫腔再粘连发生率更低，疗效更优。

Effect of Hysteroscopic Cold Knife Separation and Electrotomy in the Treatment of Intrauterine Adhesion and its Effect on the Recovery of Intrauterine Morphology and Serum Interleukin

ABSTRACT Objective: To compare the efficacy of hysteroscopic cold knife separation and electrotomy in the treatment of intrauterine adhesion (IUA) and its effect on the recovery of intrauterine morphology and serum interleukin. Methods: The clinical data of 83 patients with IUA who were treated in our hospital from April 2019 to February 2021 were analyzed retrospectively. According to the different operation methods, the patients were divided into group A (electrosurgical resection under hysteroscopy, 40 cases) and group B (cold knife separation under hysteroscopy, 43 cases). The operation time and hospital stay, the recovery of uterine morphology and the changes of serum interleukin were compared between the two groups. The incidence of postoperative complications, the improvement rate of menstruation and the incidence of uterine re adhesion were observed. Results: The operation time and hospital stay in group B were shorter than those in group A(P<0.05). The total effective rate and satisfactory rate of epithelial healing of intimal wound in group B were higher than those in group A(P<0.05). The levels of serum interleukin-6 (IL-6) and interleukin-8 (IL-8) in group B were higher than those in group A (P<0.05). The levels of serum interleukin-4 (IL-4) and interleukin-10 (IL-10) in group B were lower than those in group A(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The improvement rate of menstruation in group B was higher than that in group A, and the incidence of uterine re adhesion was lower than that in group A(P<0.05). Conclusion: Compared with hysteroscopic electrotomy in the treatment of IUA, hysteroscopic cold knife separation in the treatment of IUA has shorter operation time and hospital stay, better recovery of uterine morphology and improvement of menstruation, milder inflammatory reaction, lower incidence of uterine re adhesion and better curative effect.