观察三角球囊与金属圆形节育器对中重度宫腔粘连（IUA）患者术后粘连程度改善情况并重点分析对术后复发率的影响。

选取惠州市中心人民医院妇科2019年1月~2021年8月收治的81例中重度IUA患者，采用完全随机分组法分为研究组（41例）和对照组（40例），所有患者均在医院接受宫腔粘连分离术（TCRA）治疗，对照组术毕即置入金属圆形节育器，观察组术后放置三角球囊，2组术后均给予抗生素治疗2 d，给予小剂量阿司匹林、雌激素贯彻治疗3个月。比较2组术前、术后1个月、2个月、3个月时美国生育协会（AFS）评分；比较2组术前、术后7 d时炎症因子［肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6］；比较2组术前、术后3个月时影像学指标［子宫内膜厚度、子宫内膜容积（EV）、子宫内动脉血流指数（FI）、血管血流指数（VFI）］及随访6个月内复发率。

经广义估计方程分析显示，通过对截距项（P＜0.001）、组别（P＜0.001）、时点（P＜0.001）及组别时点交互（P＜0.001）固定效应的显著性检验显示，2组患者在术后1个月、2个月、3个月时AFS评分存在显著性差异。2组术后3个月时，子宫内膜厚度较术前增厚，EV较术前增大，FI、VFI值较术前升高，且研究组子宫内膜厚度较对照组厚，EV较对照组大，FI、VFI值较对照组高，差异有统计学意义（P＜0.05）。2组术后7 d时，TNF-α、IL-6水平均降低，且观察组水平较对照组低，差异有统计学意义（P＜0.05）。随访6个月，研究组总复发31.71%，低于对照组55.00%，差异有统计学意义（P＜0.05）。

三角球囊与金属圆形节育器用于中重度IUA患者术后均可减轻粘连程度，且三角球囊应用效果更加显著，可进一步改善子宫内膜结构和血流状况，减轻炎症反应，更利于降低复发风险。

To compare the efficacy of triangular balloon and metal circular contraceptive device in improving moderate and severe postoperative intrauterine adhesions (IUA), and to analyze their effect on postoperative recurrence.

Eighty-one patients with moderate and severe IUA treated at the Department of Gynecology of Huizhou Municipal Central Hospital from January 2019 to January 2021 were selected. The complete random grouping method was used to divide them into either a study group (41 cases) or a control group (40 cases), and all patients were treated by transcervical resection of adhesion (TCRA) in the hospital. The control group was implanted with metal circular contraceptive device immediately after operation, and the observation group was placed with triangular balloon after operation. Both groups were treated with antibiotics for 2 days and low-dose aspirin and estrogen for 3 months. The American Fertility Association (AFS) scores before operation and 1 month, 2 months, and 3 months after operation were compared between the two groups. Inflammatory factors [tumor necrosis factor (TNF)-α and interleukin (IL)-6] before and 7 days after operation, imaging indexes [endometrial thickness, endometrial volume (EV), internal uterine artery blood flow index (FI), and vascular blood flow index (VFI)] before and 3 months after operation, and the recurrence rate within 6 months after follow-up were also compared between the two groups.

The analysis of generalized estimation equation showed that, through the significance test of the fixed effects of intercept term (P＜0.001), group (P＜0.001), time point (P＜0.001), and group time point interaction (P＜0.001), it was found that there were significant differences in AFS scores between the two groups at 1 month, 2 months, and 3 months after operation. The endometrial thickness was higher, EV was larger, and the values of FI and VFI were higher at 3 months after operation compared with those before intervention in both groups. Compared with the control group, the endometrial thickness of the study group was higher, EV was larger, and the values of FI and VFI were higher; the differences were statistically significant (P＜0.05). At 7 days day after operation, the levels of TNF-α and IL-6 in both groups decreased significantly, and the levels in the observation group were significantly lower than those in the control group (P＜0.05). After 6 months of follow-up, the total recurrence in the study group was 31.71%, which was significantly lower than that of the control group (55.00%; P＜0.05).

Both triangular balloon and metal circular contraceptive device can reduce the degree of adhesion in patients with moderate and severe postoperative IUA, but the efficacy of triangular balloon is more significant and it can further improve the structure and blood flow of the endometrium, reduce inflammatory reaction, and reduce the risk of recurrence.