剖宫产史对继发性不孕影响的病例对照研究  

A case-control studyof secondaryinfertilitypatients grouped byhistoryof cesarean section

作　　者：程晓彤 邓姗[1] 孙爱军[1] 田秦杰[1] 陈蓉[1] CHENG Xiao-tong;DENG Shan;SUN Ai-jun;TIAN Qin-jie;CHEN Rong(Department of Obstetrics & Gynecology,Peking Union Medical College Hospital,Peking Union Medical College/Chinese Academy of Medical Sciences,Beijing 100730;Shenyang Women’s & Children’s Hospital,Shenyang 110011)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院妇产科,北京100730 [2]沈阳市妇婴医院,沈阳110011

出　　处：《生殖医学杂志》2019年第8期901-905,共5页Journal of Reproductive Medicine

摘　　要：目的探讨剖宫产史对后期继发性不孕相关因素及治疗后妊娠结局的影响。方法收集2012年7月至2018年6月收治于北京协和医院妇产科,因特发性不孕接受宫腹腔镜联合手术的患者中存在剖宫产史的病例65例作为研究组,采用1:1病例对照研究方法选取同期入院的非剖宫产后特发性继发不孕患者65例为对照组。症状指标包括异常子宫出血、慢性盆腔痛及痛经情况;结局指标包括宫腹腔镜联合手术中不孕相关因素及术后妊娠结局。结果研究组中异常子宫出血、慢性盆腔痛、痛经发生率均高于对照组(分别为16.9%vs.4.6%;15.4%vs.4.6%;30.8%vs.15.4%;P均<0.05);除研究组盆腔非附件区粘连发生率高于对照组外(36.9%vs.3.1%;P<0.05),两组宫腔粘连、附件区粘连及盆腔子宫内膜异位症的发生率和输卵管通畅情况均无显著差异(P均>0.05);宫腔异常除剖宫产瘢痕缺陷外亦无显著差异(P>0.05)。研究组患者术后自然妊娠率与对照组相比无显著差异(P>0.05),70%~80%自然妊娠发生在术后半年内。结论单纯剖宫产史并不增加输卵管因素、盆腔子宫内膜异位症、宫腔粘连等常见继发不孕相关因素的发生率,亦不降低自然生育力。Objective:To investigate the effect of cesarean section on secondary infertility related factors and the postoperative pregnancy outcomes.Methods:A case-control(1:1)observational study was conducted in Peking Union Medical College Hospital from July 2012 to June 2018.Sixty five patients with unexplained secondary infertility and history of cesarean section,who underwent hysteroscopy and laparoscopic surgery,were selected as the study group.The control group consisted of 65 unexplained secondary infertile patients without history of cesarean section,who underwent hysteroscopy and laparoscopic surgery at the same period.The symptoms including abnormal uterine bleeding,chronic pelvic pain and dysmenorrheal,and the outcome indicators including the related factors of infertility in intraoperative diagnosis and the postoperative pregnancy outcome were all concerned.Results:The incidence of abnormal uterine bleeding(16.9%vs.4.6%),chronic pelvic pain(15.4%vs.4.6%)and dysmenorrhea(30.8%vs.15.4%)in the study group was significantly higher than those in the control group(all P<0.05).The incidence of non-adnexal adhesions in the study group was significantly higher than that in the control group(36.9%vs.3.1%,P<0.05).No statistical differences were found in the incidence of intrauterine adhesion,adnexal adhesions,pelvic endometriosis and fallopian tube patency between the two groups(P>0.05).No abnormity of uterine cavity was found except previous caesarean scar defect(PCSD)between the two groups(P>0.05).Postoperative spontaneous pregnancy rate in study group was not significantly different from the control group(P>0.05).70%-80%patients were pregnant spontaneously within 6 months after surgery.Conclusions:The history of cesarean section alone does not increase the incidence of common secondary infertility-related factors such as fallopian tube patency,pelvic endometriosis and intrauterine adhesions,or reduce natural fertility.

关 键 词：剖宫产 继发不孕 不孕因素 妊娠结局 

分 类 号：R713.4[医药卫生—妇产科学]