摘要目的:探讨比较COOK球囊和防粘连膜包裹宫内节育器（IUD）预防中至重度宫腔粘连术后再粘连的临床效果。方法:对2015年12月至2018年2月于武警广东省总队医院妇产科行宫腔粘连手术患者75例进行回顾性分析，分为两组，A组行宫腔镜宫腔粘连分离术后放置COOK球囊，B组术后放置防粘连膜包裹金属圆环。术后两组均给予人工周期治疗，补佳乐4 mg/d，共21 d，后10 d加地屈孕酮，10 mg/d，术后第1次月经干净3～7 d内行宫腔镜二次探查。A组患者宫腔镜检查同时取出COOK球囊，B组则取出IUD，详细观察及描述两组患者宫腔恢复情况，比较两组患者术后再粘连、月经恢复、月经伴随症状（如腰酸腹痛）及有无不规则阴道流血情况。结果:宫腔粘连：A组总有效率为75.68%，B组总有效率为71.05%；月经改善：A组总有效率为75.68%，B组总有效率为73.68%；术后1年妊娠情况：A组妊娠率为13.5%，B组为10.5%；两组宫腔粘连、月经改善及术后1年妊娠情况比较，差异均无统计学意义（均 P>0.05）。术后A组患者未发生腰酸腹痛、不规则阴道出血情况；B组患者发生IUD嵌顿2例，发生腰酸腹痛9例，不规则阴道出血7例，取出IUD后症状均缓解；两组腰酸腹痛和不规则阴道流血情况比较，差异均有统计学意义（均 P<0.05）。 结论:COOK球囊和防粘连膜包裹宫内节育器预防宫腔粘连术后再粘连的疗效相当，但IUD容易出现环嵌顿及引起患者月经伴随症状，COOK球囊较防粘连膜费用更低。

abstractsObjective:To compare the clinical effects of COOK balloon and intrauterine device (IUD) coated by anti-adhesion membrane in preventing post-operative readhesion of moderate to severe uterine adhesion.Methods:A retrospective analysis on 75 patients undergoing uterine adhesion surgery in department of obstetrics and gynecology of our hospital from December 2015 to February 2018 was conducted. They were divided into two groups. In group A, COOK balloon was placed after hysteroscopic uterine adhesion separation, and the metal ring coated by anti-adhesion membrane was placed in group B. After the surgery, both groups were given artificial cycle therapy, Progynova 4 mg/d for 21 d, combined with dydrogesterone 10 mg/d in the last 10 d. The hysteroscopy was performed again at 3-7 d after the end of postoperative first menstrual period. COOK balloon was taken out during the hysteroscopy in group A, and IUD was taken out in group B. The recovery of the uterine cavity in the 2 groups were observed and described in detail, the postoperative readhesion, menstrual recovery, menstrual symptoms such as soreness of waist and abdominal pain, irregular vaginal bleeding of the 2 groups were compared.Results:The total effective rate of uterine adhesion was 75.68% in group A, 71.05% in group B; the total effective rate of menstrual improvement was 75.68% in group A, 73.68% in group B; the rate of pregnancy within 1 year after surgery was 13.5% in group A, 10.5% in group B; there were no statistically significant differences ( P>0.05). There were no soreness of waist or abdominal pain, irregular vaginal bleeding in group A, there were 2 cases of IUD embedding, 9 cases of soreness of waist and abdominal pain, 7 cases of irregular vaginal bleeding in group B, which were relieved after the IUD removed; there were statistically significant differences in the incidences of soreness of waist and abdominal pain, irregular vaginal bleeding between the two groups ( P<0.05). Conclusion:COOK balloon and intrauterine device (IUD) coated by anti-adhesion membrane are both quite effective in preventing post-operative readhesion, but the IUD is prone to ring embedding and may cause menstrual symptoms, and COOK balloon is less expensive than anti-adhesion membrane.