综合治疗中重度宫腔粘连的疗效观察

发布时间：2018-07-26 10:43

【摘要】：目的探讨以宫腔镜下宫腔粘连电切术(TCRA)为主的综合治疗方法对中重度宫腔粘连(IUA)的治疗效果。方法对以宫腔镜电切术为主综合治疗的中重度宫腔粘连165例(中度83例,重度82例)患者的临床资料进行回顾性分析。根据术后服用戊酸雌二醇剂量和周期数不同分为三组:A组9mg/d,3个周期;B组6mg/d,2个周期;C组4mg/d,1个周期。术后3个月观察疗效并随访妊娠结局。结果 165例患者的有效率为85.5%(141/165);中位随访时间23个月(8~46个月),受孕率(包括流产、活产)为43.6%(72/165),活产率为50.0%(36/72)。中度IUA治疗的有效率(92.8%,77/83)高于重度IUA(78.0%,64/82;P0.05)。中度A、B、C组的有效率分别为95.2%(20/21)、95.7%(22/23)和89.7%(35/39);重度A、B、C组的有效率为73.9%(17/23)、78.6%(22/28)和80.6%(25/31),三组比较,差异均无统计学意义(P0.05)。结论中度IUA临床疗效明显优于重度IUA;TCRA术后4~6mg戊酸雌二醇周期序贯应用及早期宫腔镜复查也可取得良好效果。
[Abstract]:Objective to investigate the effect of hysteroscopic electroresection of intrauterine adhesions (TCRA) on moderate and severe intrauterine adhesions (IUA). Methods the clinical data of 165 patients with moderate or severe intrauterine adhesions (83 moderate and 82 severe) treated by hysteroscopic electroresection were retrospectively analyzed. According to the dosages and periods of estradiol valerate after operation, they were divided into three groups: group A 9 mg / d, group B 6 mg / d, group C 4 mg / d, and group C 4 mg / d, 1 cycle. The curative effect was observed and pregnancy outcome was followed up 3 months after operation. Results the effective rate of 165 patients was 85.5% (141 / 165), the median follow-up time was 23 months (8 ~ 46 months), the pregnancy rate (including abortion, live birth) was 43.6% (72 / 165), the live birth rate was 50.0% (36 / 72). The effective rate of moderate IUA (92.8 / 77 / 83) was higher than that of severe IUA (78.0% / 82% P 0.05). The effective rates were 95.2% (20 / 21) or 95.7% (22 / 23) and 89.7% (35 / 39) in group C and 73.9% (78.6%) and 80.6% (25 / 31) in group C and group C, respectively. There was no significant difference among the three groups (P0.05). Conclusion the clinical efficacy of moderate IUA is significantly better than that of 4~6mg after severe IUAC. The sequential application of estradiol valerate and early hysteroscopy can also achieve good results.
【作者单位】：湖北省妇幼保健院妇科;
【基金】：湖北省卫生厅青年科技人才项目(QJX2010-39)
【分类号】：R711.74

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