宫腔粘连综合治疗218例预后分析  

Analysis of prognosis after comprehensive treatment for 218 cases of intrauterine adhesion

作　　者：黄燕明[1] 王燕[1] 郎雁[1] 余炜昶[1] 邢琦[1] 董毅[1] 刘玉兰[1] 陈璐[1] 方琳[1] 

机构地区：[1]湖北省妇幼保健院妇科,湖北武汉430070

出　　处：《中国实用妇科与产科杂志》2015年第11期1025-1028,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：湖北省卫生厅青年科技人才项目(QJX2010-39)

摘　　要：目的探讨以宫腔镜电切术为主的综合治疗方法对宫腔粘连（intrauterine adhesion，IUA）预后的影响。方法对2010年1月至2013年6月湖北省妇幼保健院因IUA行电切手术的218例患者临床资料进行回顾性分析。各程度IUA根据术后补充雌激素剂量和周期数不同分为3组，A组9mg／d，服用3周期；B组6mg／d，服用2周期；C组4mg／d，服用1周期。观察3周期后月经恢复及宫腔情况并随访妊娠结局。结果宫腔恢复良好86．2％（188／218），月经改善75．7％（165／218）；随访8～46个月，受孕44．5％（97／218），活产48．5％（47／97）。Ⅱ度与Ⅲ度IUA的宫腔恢复率、月经改善率差异无统计学意义（P〉0．05），但二者与Ⅳ度以上IUA的宫腔恢复率、月经改善率差异均有统计学意义（P〈0．05）。在相同程度IUA中A、B、C3组比较，宫腔恢复率、月经改善率差异均无统计学意义（P〉0．05）。结论以宫腔镜电切术为主的综合治疗方法对IUA治疗效果良好；轻、中度IUA预后明显好于重度IUA；适当减少雌激素剂量，缩短治疗周期对IUA预后无明显影响。Objective To evaluate the prognosis of comprehensive treatment with a predominance of hysteroscopic eleetrosurgery in the treatment of intrauterine adhesion （IUA）. Methods A retrospective analysis was performed on 218 patients who were treated with hysteroscopic electrosurgery between January 2010 and June 2013 at Huhei Province Maternal and Child Health Hospital. According to the treatment of estrogen dosage and cycles after operation, the patients were divided into A, B and C group. They were treated with 9 mg/day Estradiol valerate（E2V）for three cycles, 6 rag/day E2V for two cycles, 4 mg/day E2V for one cycle, respectively. The shape of uterus cavity and menstrual cycle were evaluated after three months and the pregnancy rate was followed up. Results The shape of uterus cavity returned to basically normal in 86.2% of the patients （188/218）. Menstruation improved in 75.7% of the patients （165/218）. The pregnancy rate after operation was 44.5% （97/218） and the live delivery rate was 48.5% （47/97）. There was no difference in the rate of recovery of uterus cavity and the rate of menstrual improvement between Ⅱ and m degree IUA （P 〉0.05）. But comparing them between Ⅱ and Ⅳ degree of IUA or above, between Ⅲ and Ⅳ degree IUA or above, the difference was significant （P〈0.05）. At the same degree of IUA, there was no difference in the rate of recovery of uterus cavity and the rate of menstrual improvement among group A, B and C （P 〉0.05）. Conclusion The comprehensive treatment with a predominance of hysteroscopic electrosurgery in the treatment of IUA is effective. The prognosis of mild or moderate IUA is better than severe IUA. Reducing dosage of estrogen and shortening treatment cycles appropriately would not affect the prognosis of IUA.

关 键 词：宫腔粘连 宫腔粘连电切术 雌激素 宫腔镜 

分 类 号：R711.74[医药卫生—妇产科学]