80例宫腔粘连的临床回顾分析

发布时间：2018-05-28 15:08

本文选题：宫腔粘连 + 宫腔粘连分离术　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]通过了解我院收治的80例宫腔粘连患者病因,辅助检查结果及临床症状、首次宫腔镜检查宫腔粘连情况、二探时宫腔形态恢复及复粘率,从而评价宫腔粘连患者行宫腔镜下宫腔粘连分离术的有效性,及术后放置水囊并联合雌激素或雌、孕激素人工周期治疗后的宫腔形态恢复、月经改善情况及妊娠率。[方法]对2015年06月至2015年12月昆明医科大学第一附属医院门诊及住院部宫腔粘连的80例患者进行回顾性分析,患者均采用微型剪刀行宫腔镜下宫腔粘连分离术,术毕根据粘连程度放置水囊数小时至数天不等,轻、中度患者术后予戊酸雌二醇2片/Bid连续治疗21天,后11天加服地屈孕酮1片/Bid,停药转经,待下次月经干净后行二次宫腔镜检查,同时开始第二周期服药(方法同前),共三个周期;重度患者术后亦予以戊酸雌二醇2片/Bid连续无间断治疗三个周期,于最后10天加服地屈孕酮1片/Bid,重度患者于1月后进行二次宫腔探查。二次宫腔镜检查方法同第一次手术,如发现复粘,同法用微型剪刀分离粘连。术前术后均采用美国生育协会(AFS)标准对宫腔粘连程度进行评分,随访二探时宫腔形态,二探12个月后月经量改善、腹痛缓解、再次妊娠情况。所获数据理采用SPSS 17.0统计学软件处理,计数资料与计量资料分别以百分比(%)、均数±标准差(x±s)格式表示,计量资料组间均数比较采用单因素方差分析,计数资料组间比较采用χ2检验,以P0.05表示差异有统计学意义。[结果]80例患者依宫腔粘连程度分为轻度粘连24例,中度粘连36例,重度粘连20例。不同宫腔粘连程度的TCRA术前及术后AFS评分差异均有统计学意义(p0.05),AFS评分术后较术前明显下降。二探时总体宫腔形态恢复率达85%(68/80例)。术前60例出现月经改变(经量较少+闭经)IUA患者,总月经改善率为90%(54/60例)。宫腔粘连分离术后患者有效率达91.3%,26例继发性不孕患者,截止随访时,再次妊娠的有15例,总妊娠率达57.7%。[结论]宫腔镜下利用微型剪刀的宫腔粘连分离术是治疗宫腔粘连的有效方式,术后放置水囊并使用雌激素或雌、孕激素人工周期治疗可有效避免宫腔再次粘连,增加月经量,提高妊娠率。
[Abstract]:[objective] to investigate the etiology, auxiliary examination results and clinical symptoms of 80 cases of intrauterine adhesions in our hospital, the first hysteroscopy to examine the condition of intrauterine adhesions, and the recovery of uterine cavity morphology and the rate of readhesive during the second visit. In order to evaluate the effectiveness of hysteroscopic separation of intrauterine adhesions in patients with intrauterine adhesions, the uterine cavity morphology, menstrual improvement and pregnancy rate after implantation of water sac combined with estrogen or estrogen, progesterone and artificial cycle therapy were evaluated. [methods] from June 2015 to December 2015, 80 patients with intrauterine adhesions in outpatient and inpatient department of the first affiliated Hospital of Kunming Medical University were retrospectively analyzed. At the end of the operation, according to the degree of adhesion, the water sac was placed for several hours to several days. The mild and moderate patients were treated with estradiol valerate 2 / bid continuously for 21 days after the operation. After 11 days, they were given diproprogesterone 1 / Bidder, and stopped the drug transfer. After the next menstruation was clean, the second hysteroscopy was performed, and the second cycle of medication was started. (the same method was used in three cycles, and the severe patients were also treated with estradiol valerate 2 / bid for three consecutive cycles without interruption. On the last 10 days, Diproprogesterone 1 / Bid1 was added, and severe patients underwent second intrauterine exploration after 1 month. The second hysteroscopy is the same as the first operation, if complex adhesion is found, the adhesions are separated with microscissors. The degree of intrauterine adhesions was evaluated by the American Fertility Association (AFS) standard before and after operation. The uterine cavity morphology was followed up 12 months later, the menstrual volume was improved, abdominal pain was alleviated, and pregnancy was repeated. The obtained data were processed by SPSS 17.0 statistical software. The counting data and the measurement data were expressed in the format of percentage and mean 卤standard deviation respectively. The mean of the measurement data groups was compared by single factor analysis of variance (ANOVA). 蠂 2 test was used to compare the counting data between groups, and the difference was statistically significant with P0.05. [results] according to the degree of intrauterine adhesion, 80 cases were divided into mild adhesion (24 cases), moderate adhesion (36 cases) and severe adhesion (20 cases). There were significant differences in AFS scores before and after TCRA with different degree of intrauterine adhesion. The overall recovery rate of uterine cavity shape was 85%, 68% and 80 cases. There were 60 cases with menorrhagia before operation. The total menorrhagia improvement rate was 90% 54 / 60 cases. The effective rate was 91.3% in 26 cases of secondary infertility. At the end of follow-up, 15 cases were pregnant again, and the total pregnancy rate was 57.7%. [conclusion] the intrauterine adhesion separation with microscissors under hysteroscopy is an effective method for the treatment of intrauterine adhesions. After the implantation of water sac and estrogen or estrogen, progesterone artificial cycle therapy can effectively avoid uterine cavity adhesion again and increase menstrual volume. Increase the pregnancy rate.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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