生殖医学杂志

目的探讨宫腔镜在人工流产术后宫腔粘连(IUA)诊治中的应用效果。方法回顾性分析我院生殖调节科2014年1月至2016年1月收治的因人工流产术后IUA行宫腔粘连分离术(TCRA)的85例患者的临床资料。根据IUA的程度不同分为3组:轻度粘连组、中度粘连组和重度粘连组。分别行腹腔镜监测下或B超监测下的TCRA术,术后放置宫内节育器(IUD)并给予常规激素序贯治疗,观察各组患者月经改善及宫腔恢复情况。结果 85例患者TCRA术后宫腔恢复正常者67例(78.8%),月经改善62例(72.9%)。轻度粘连与中度粘连患者比较,TCRA术后宫腔恢复率和月经改善率无显著性差异(P>0.05);但轻度、中度粘连组术后的宫腔恢复率(分别为94.4%、76.3%)和月经改善率(分别为86.1%、73.7%)均显著高于重度粘连组(宫腔恢复率36.4%、月经改善率27.3%)(P<0.05)。结论宫腔镜下TCRA联合术后放置IUD及雌-孕激素序贯治疗对人工流产术后IUA治疗效果良好,轻、中度IUA预后明显好于重度IUA。

Objective: To evaluate the application of hysteroscope in diagnosis of intrauterine adhesion(IUA)after induced abortion and clinical effect of transcervical resection of adhesions(TCRA).Methods: A retrospective analysis was performed in 85 patients who were treated with TCRA after diagnosis of intrauterine adhesion in Beijing Obstetrics and Gynecology Hospital from January 2014 to January 2016.According to serious degree of intrauterine adhesion,the patients were divided into three groups.TCRA was performed under laparoscopy or B-mode ultrasonography,and intrauterine device(IUD)and routine sequential hormone therapy were administrated.The shape of uterus cavity and menstrual cycle in every group were followed up.Results: The shape of uterus cavity returned to basically normal in 78.8% of the patients(67/85).Menstruation improvement was in 72.9% of the patients(62/85).There were no differences in the uterus recovery rate and the menstrual improvement rate between mild and moderate degree IUA groups(P>0.05).The uterus recovery rate(94.4% vs.76.3% vs.36.4%)and the menstrual improvement rate(86.1% vs.73.7% vs.27.3%)in mild or moderate degree IUA groups were significantly higher than those in severe degree IUA groups(P<0.05).Conclusions: Hysteroscopic TCRA combined with postoperative intrauterine device and estrogenprogestin sequential therapy for IUA after abortion is effective.The prognosis of mild or moderate IUA is better than severe IUA.