宫腔镜下子宫中隔切除术后防宫腔粘连方法的探讨  

Exploration of the prevention methods of intrauterine adhesions after TCRS

作　　者：曹华斌[1] 涂灵[1] 罗明燕[1] 钟小玲[1] 

机构地区：[1]江西省妇幼保健院生殖健康科,江西南昌330006

出　　处：《中国内镜杂志》2011年第11期1138-1141,共4页China Journal of Endoscopy

摘　　要：目的探讨子宫中隔患者行宫腔镜子宫中隔切除术(TCRS)后防止宫腔粘连的方法及效果。方法回顾性分析2004年1月～2010年1月在该院门诊宫腔镜中心确诊为子宫中隔并排除其他不孕不育因素的患者共212例实施了TCRS手术,按术后预防宫腔粘连的处理方式分成4组:宫腔内仅放置节育环组(A组),单用雌孕激素序贯治疗组(B组),宫内放置节育器和雌孕激素序贯治疗组(C组),未用任何处理组(D组)。结果在后续随访中,发现14.22%的患者有残余子宫中隔,4.74%有宫腔粘连,经统计学分析组间比较差异均无显著性。在A,B,C,D组患者术后的宫腔粘连发生率分别为7.55%,6.00%,1.92%和3.51%,术后妊娠率分别为35.85%,40.00%,42.31%和45.61%,流产率分别为5.66%,6.00%,5.77%和8.77%,经统计学分析各组间术后宫腔粘连率、妊娠率及流产率发生率差异均无显著性。结论对子宫中隔患者行TCRS时宫内放置节育环和(或)加用雌激素治疗在预防宫腔粘连或提高术后妊娠率没有明显作用。[Objective] To assess the effectiveness of the prevention methods of intrauterine adhesions after TCRS.[Methods] A retrospective analysis of 211 patients received TCRS was made after diagnosed as uterine septum in our outpatient hysteroscopy from January 2004 to January 2010.According to the prevention methods of intrauterine adhesions after the treatment the patients were divided into 4 groups：IUD treatment（group A）,estrogens treatment（group B）,IUD plus estrogens treatment（group C）,and no treatment（group D）.[Results] In the subsequent follow-up,14.22% of patients had residual septum,4.74% had intrauterine adhesions.The differences between groups were not significant.For the four groups,the incidence of intrauterine adhesions after surgery were 7.55%,6%,1.92% and 3.51%,pregnancy rate were 35.85%,40%,42.31% and 45.61%,and the abortion rate were 5.66%,6%,5.77% and 8.77%,respectively.None of the differences were significant.[Conclusions] IUD placement and/or estrogen treatment play no role in the prevention of intrauterine adhesions or the maintenance of pregnancy after hysteroscopic treatment of septate uterus.

关 键 词：宫腔镜电切术 子宫中隔 雌激素 宫内节育环 

分 类 号：R713.4[医药卫生—妇产科学]