重度宫腔粘连综合治疗的临床结局分析  

Clinical results of severe intrauterine adhesion women following a comprehensive management

作　　者：张露平[1] 赵卫红[1] 杨保军[1] 徐云[1] 冯力民[1] ZHANG Luping ZHA YANG Baojun XU Yun FENG Limin.(Depaernent of Obstetrics and Gynecology, Beijing Tian Tan Hospital, Capital Medical Universit)

机构地区：[1]首都医科大学附属北京天坛医院妇产科,北京100050

出　　处：《中国妇产科临床杂志》2017年第3期221-223,共3页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨和分析重度宫腔粘连患者综合治疗后的临床效果,描述宫腔粘连的综合管理模式,观察患者治疗前后月经模式的改变及妊娠结局。方法回顾性分析2011年4月至2015年5月在首都医科大学附属北京天坛医院妇科进行治疗并且完成随访的有生育要求的重度宫腔粘连患者共75例,术前进行宫腔镜检查及AFS评分,并给予药物营养子宫内膜治疗2个月,再行宫腔镜下宫腔粘连分解术,术后2个月行宫腔镜二次探查,随访患者治疗前后月经模式的改变及妊娠结局。结果 75例患者平均年龄(32.05±5.06)岁,药物治疗后月经模式改善率为57.33%。宫腔镜下宫腔粘连分解术后90.67%患者粘连程度降级,月经改善率92%,妊娠率49.33%,有效妊娠率72.97%。结论术前药物营养子宫内膜可以改善患者的月经模式及AFS评分,部分患者发生粘连的降级。目前宫腔镜下粘连分解术仍是重度宫腔粘连诊治的主要手段,术后最好在一年内妊娠,未妊娠者建议考虑借助辅助生殖技术来提高术后的妊娠结局。Objective To describe a comprehensive method for women with severe intrauterine adhesion and evaluate its reproductive outcome. Methods This was a retrospective clinical study. 75 patients with severe intrauterine adhesion and fertility requirement had underwent a comprehensive therapy as following. First step, hysteroscopy assessment of adhesion and preoperative medical treatment. Second, hysteroscopic adhesiolysis. Postoperative medical treatment were as same as preoperative and then hysteroscopy was performed two months after the first one. Clinical effect were evaluated by subsequent resumption of menses and conception. Results The mean age of 75 patients was （32.05 - 5.06） years. After medical therapy, menstrual pattern improvement rate was 57.33 %. After adhesiolysis, uterine adhesive degree of 68 patients（90.67%）alleviated, menstrual pattern improvement rate was 92 %. Conception rate was 49.33%, the effective conception rate was 72.97%. Conclusions Medical therapy could improve menstrual pattern and AFS score. Adhesiolysis could still be the main treatment approach for uterine adhesion. The best time of pregnancy was within one year after therapy, otherwise reproductive technology to improve pregnancy outcome should be considered.

关 键 词：宫腔粘连 ASHERMAN综合征 宫腔镜 粘连分解术 

分 类 号：R713.4[医药卫生—妇产科学]