不同程度宫腔粘连宫腔镜术后的转归分析

发布时间：2018-06-06 06:23

本文选题：宫腔粘连 + 宫腔镜治疗　；参考：《华中科技大学学报(医学版)》2016年05期

【摘要】：目的评价不同程度宫腔粘连患者行宫腔镜下粘连分解术,术后放置元宫环并联合雌、孕激素人工周期治疗后的宫腔形态改变、复粘率、月经恢复情况及妊娠率。方法对同济大学附属第一妇婴保健院2013年6月至2015年6月宫腔粘连的患者进行回顾性分析,共67例患者行宫腔镜下宫腔粘连分解术,术后予以炔雌醇及醋酸甲地孕酮序贯治疗,3个疗程后再次行宫腔镜检查了解宫腔形态。术前术后均采用美国生殖协会(AFS)标准对宫腔粘连程度进行评分,随访月经量改变,复粘率及妊娠率。结果术后随访5~16个月,67例中随访成功且有生育意愿者63例。63例患者依宫腔粘连程度分为:轻度粘连29例,中度粘连20例,重度粘连14例。通过宫腔镜二次探查发现轻度宫腔粘连者的复粘率为13.8%,中度宫腔粘连复粘率为40.0%,重度宫腔粘连复粘率为57.1%。86.2%轻度粘连者、90.0%中度粘连者、100.0%重度粘连者经量增多(包括恢复至正常)。术后随访妊娠18例,总妊娠率为28.6%(18/63),其中轻度粘连者术后妊娠率为37.9%(11/29),中重度粘连者妊娠率为20.5%(7/34)。妊娠患者中5例(27.8%)足月妊娠,3例(16.7%)稽留流产,9例(50.0%)继续妊娠中,1例(5.6%)异位妊娠。结论宫腔镜下宫腔粘连分解术后放置宫内节育器可有效避免宫腔再次粘连,术后使用雌、孕激素人工周期治疗修复内膜,可增加子宫内膜容受性,从而增加妊娠的机会。
[Abstract]:Objective to evaluate the changes of uterine cavity morphology, relapse rate, menstrual recovery and pregnancy rate after hysteroscopy in patients with different degree of intrauterine adhesions. Methods 67 patients with intrauterine adhesions were retrospectively analyzed from June 2013 to June 2015 in the first affiliated Hospital of Tongji University. A total of 67 patients were treated with hysteroscopic hysteroscopy. After 3 courses of treatment, hysteroscopy was performed again to understand the shape of uterine cavity after the sequential treatment of ethylestradiol and megestrol acetate. The degree of intrauterine adhesions was evaluated by the American Reproductive Association (AFS) standard before and after operation, and the changes of menstrual volume, the rate of complex adhesion and the rate of pregnancy were followed up. Results among the 67 cases of postoperative follow-up for 5 to 16 months, 63 cases were followed up successfully and had fertility intention. According to the degree of intrauterine adhesions, 29 cases were mild adhesions, 20 cases were moderate adhesions, and 14 cases were severe adhesions. Through the second exploration of hysteroscopy, it was found that the rate of complex adhesion was 13.8in mild adhesions of uterine cavity, 40.0in moderate adhesions and 57.1. 86.2% in patients with severe intrauterine adhesions. 90.0% of patients with mild adhesions had moderate adhesions and 100.0% patients with severe adhesions (including returning to normal). 18 cases of pregnancy were followed up, the total pregnancy rate was 28. 6% or 18 / 63, among which the pregnancy rate of mild adhesions was 37. 9% and that of moderate and severe adhesions was 20. 5 / 734%. There were 5 cases (27.8%) with full-term pregnancy (3 cases with 16. 7) missed abortion in 9 cases (50. 0) and 1 case with ectopic pregnancy in 1 case (5. 6). Conclusion implantation of intrauterine device after hysteroscopy can effectively avoid intrauterine adhesions. Artificial cycles of estrogen and progesterone are used to repair endometrium after hysteroscopy, which can increase the receptivity of endometrium and increase the chance of pregnancy.
【作者单位】：同济大学附属第一妇婴保健院妇科;
【基金】：国家自然科学基金资助项目(No.81572546,81471436) 上海市科委产学研医项目(No.12DZ1940408) 上海市市级医院新兴前沿技术联合攻关项目(No.SHDC12013125) 上海市自然科学基金资助项目(No.15ZR1433300)
【分类号】：R713.4

【相似文献】