宫腔镜下宫腔粘连分离术后综合治疗的临床应用效果观察  

Observation on the clinical effect of comprehensive treatment after transcervical resection of adhesion

作　　者：潘秀婷 李容芳 李煜文 PAN Xiuting;LI Rongfang;LI Yuwen(Department of Obstetrics and Gynecology,Nanhai District Fourth Peoplets Hospital ,Foshan 528211,Guangdong,China)

机构地区：[1]佛山市南海区第四人民医院妇产科,广东佛山528211

出　　处：《中国性科学》2019年第4期73-77,共5页Chinese Journal of Human Sexuality

基　　金：广东省佛山市医学类科技攻关项目(2017AB000892)

摘　　要：目的观察评价宫腔镜下宫腔粘连分离术后综合治疗的临床应用效果。方法选取2015年1月至2017年7月佛山市南海区第四人民医院采用宫腔镜下宫腔粘连分离术结合综合诊治的45例患者作为研究对象。术毕4例使用透明质凝胶,11例放置宫内节育器,15例放置COOK球囊支架,预防粘连。术后采用雌激素序贯法人工周期治疗,最后7 d～10 d联合安宫黄体酮,停药转经第5日再次进行人工周期治疗1个～2个疗程。首次手术治疗后,再次进行宫腔镜检查,方法与初次手术同,术中发现粘连进行分离,循环处理,直至宫腔恢复正常,2个月后再次进行三维彩色超声检查,若出现可疑的粘连,再次进行宫腔镜检查。结果 1个月、3个月和6个月后,月经逐步恢复,6个月后月经恢复率达到75.56%,总有效率97.78%,差异具有统计学意义(χ~2=62.06,P=0.00)。随着时间推移,子宫粘连复发率逐渐上升,第1个月复发率0.0%、3个月8.89%,6个月15.56%,差异具有统计学意义(χ~2=103.68,P=0.000<0.05)。重复子宫粘连分离术范围1次～5次,重复子宫粘连分离术(2.6±0.5)次。随访6个月～1.1年,子宫内膜厚度、子宫容积、子宫动脉PS高于治疗前,子宫动脉、螺旋动脉PI与RI低于治疗前,差异具有统计学意义(P<0.05)。末次随访与治疗前,子宫内膜血流分型差异具有统计学意义(P<0.05),C型子宫内膜血流比重53.33%较治疗前15.56%上升。末次随访,子宫内膜连续性中断、宫腔线分离、内膜显示不清、锯齿状改变发生率分别为4.44%、0.00%、0.00%、0.00%低于治疗前57.78%、13.33%、24.44%和20.00%,差异具有统计学意义(P<0.05)。34例不孕症成功妊娠率47.06%(16/34)。宫腔镜下宫腔粘连分离术后综合治疗有一定的疗效,可改善子宫容受性,治疗不孕症,但随着时间的推移,也会出现粘连复发。Objective To observe the clinical effect of comprehensive treatment after transcervical resection of adhesion. Methods 45 patients received comprehensive treatment after transcervical resection of adhesion in our hospital from January 2015 to July 2017 were selected, including 4 cases using hyaluronic gel, 11 cases placed with intrauterine device(IUD) and 15 cases placed with COOK stent to prevent adhesion. Estrogen sequential artificial cycle therapy was performed and progesterone was given on the last 7-10 days. On the third day after withdrawal, the artificial cycle therapy was performed again for 1-2 courses. Postoperative hysteroscope examination was performed and above treatment was conducted again when adhesion was found until the uterine cavity returned to normal. 3 D ultrasound examination was performed 2 months later and hysteroscope examination would be performed again if suspected adhesion was found. Results The menstruation gradually recovered and the menstrual recovery rate reached 75.56% at 6 months later, a total efficiency of 97.78%, with statistically significant differences(χ^2=62.06, P=0.00). With the passage of time, the recurrence rate of uterine adhesions gradually increased, and the recurrence rate at the first, third and sixth month was 0%, 8.89% and 15.56% accordingly, with statistically significant differences(χ^2=103.68, P=0.000<0.05). Transcervical resection of adhesion was repeated for 1-5 times, an average of(2.6±0.5) times. Within the 6 months to 1.1 years′ follow-up, the endometrial thickness, uterine volume and uterine artery PS was higher than that before treatment, while the uterine artery, spiral artery PI and RI was lower than that before treatment, all with statistically significant differences(P<0.05). There was statistically significant difference in the endometrial blood flow classification between before treatment and at the end of follow-up(P<0.05). The proportion of type C endometrial blood flow at the end of follow-up(53.33%) was higher than that before treatment

关 键 词：宫腔粘连 宫腔粘连分离术 宫腔镜 综合治疗 临床疗效 

分 类 号：R711[医药卫生—妇产科学]