宫腹腔镜联合治疗中重度宫腔粘连的临床研究

发布时间：2018-04-23 19:03

本文选题：腹腔镜 + 宫腔粘连切除术　；参考：《青岛大学》2014年硕士论文

【摘要】：目的探讨宫腹腔镜联合治疗中重度宫腔粘连临床疗效。方法选择2012年1月～2013年10月于我院就诊、有生育要求经宫腔镜检查确诊为中重度宫腔粘连62例,其中中度23例,重度39例。所有患者均在腹腔镜下行宫腔镜手术。膨宫后针状电极划开宫颈及宫腔粘连并打开宫腔,环状电极切取粘连组织,术毕宫腔内注入透明质酸钠后宫腔置Foley导尿管注水球囊压迫,联合雌孕激素人工周期治疗3月,合并盆腔病变者同时行腹腔镜手术治疗,分别于术后1个月,3个月及6个月复查随访其月经恢复情况及宫腔形态恢复情况,对宫腔粘连复发者行二次粘连分离术。随访其月经及妊娠情况。结果62例术中同时合并盆腔病变者22例(35.48%),其中盆腔粘连8例(12.90%),输卵管积水系膜囊肿5例(8.06%),盆腔子宫内膜异位4例(6.45%),卵巢囊肿2例(3.23%),多囊卵巢3例(4.84%),分别给予相应处理。62例手术前后子宫内膜厚度变化比较差异有统计学意义(F=34.73,P0.05)。62例手术前后经期天数及月经量变化比较差异有统计学意义(F=38.92,46.53,均P0.05)。术后1、3、6个月随访,23例中度粘连患者宫腔形态恢复正常；39例重度粘连者中34例宫腔形态恢复正常,3例转为轻度粘连,2例转为中度粘连,给予再次手术。术后宫腔再粘连发生率为8.06%(5/62)。发生并发症1例,已治愈。目前已有8人获得正常妊娠。结论宫腹腔镜联合治疗中重度粘连可明显改善子宫内膜厚度,促使宫腔恢复正常形态,同时对盆腔病变予以相应处理,对于改善月经、提高正常妊娠率有较大的临床价值。
[Abstract]:Objective to investigate the clinical effect of hysteroscopy combined with laparoscopy in the treatment of moderate and severe intrauterine adhesions. Methods from January 2012 to October 2013, 62 patients with moderate or severe intrauterine adhesions were diagnosed by hysteroscopy, including 23 moderate cases and 39 severe cases. All patients underwent laparoscopic hysteroscopy. After uterine expansion, the needle electrode opened the cervical and uterine adhesions and opened the uterine cavity. The adhesive tissue was removed by ring electrode. After intrauterine injection of sodium hyaluronate, the Foley catheter was inserted into the uterine cavity for balloon compression, and the artificial cycle of estrogen and progesterone was used for 3 months. The patients with pelvic lesions were treated by laparoscopic surgery at the same time. The menstrual recovery and uterine cavity morphology were followed up at 1 month, 3 months and 6 months after operation, respectively, and secondary adhesion separation was performed in the patients with recurrent intrauterine adhesions. Their menstruation and pregnancy were followed up. Results in 62 cases, 22 cases were complicated with pelvic lesions simultaneously, including 8 cases of pelvic adhesions, 5 cases of hydrosalpinx Mesangial cysts, 5 cases of hydronephrosis, 6.45% of pelvic endometriosis, 2 cases of ovarian cysts, 3 cases of polycystic ovary and 4.84% of polycystic ovary, respectively. There were significant differences in endometrial thickness before and after operation in 62 cases (P < 0.05). There were significant differences in the days of menstrual period and menstrual volume before and after operation in 62 cases (P < 0.05). Among 39 cases with severe adhesions, 34 cases had normal uterine cavity morphology, 3 cases turned to mild adhesion and 2 cases to moderate adhesion. The incidence of postoperative intrauterine re-adhesion was 8. 06%-62%. Complications occurred in 1 case and were cured. At present, 8 people have received normal pregnancy. Conclusion the combination of hysteroscopy and laparoscopy can obviously improve the thickness of endometrium and promote the recovery of uterine cavity to normal shape. At the same time, it is of great clinical value to improve menstruation and increase the rate of normal pregnancy.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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