早期二次宫腔镜诊治宫腔镜术后粘连的效果观察  

Observation on effect of early second-look hysteroscopy in the treatment of post-surgical intrauterine adhesions

作　　者：杨蓓 庄秋婵 王祥珍[1] YANG Bei;ZHUANG Qiu-chan;WANG Xiang-zhen(Nanshan District Maternal and Child Health Hospital,Shenzhen 518000,China)

机构地区：[1]深圳市南山区妇幼保健院,518000

出　　处：《中国实用医药》2020年第26期39-42,共4页China Practical Medicine

基　　金：广东省医学科学技术研究基金项目(项目编号:A2016517)。

摘　　要：目的评估宫腔镜手术治疗宫腔粘连(IUA)、子宫内膜息肉或黏膜下肌瘤后患者出现IUA的发生率,并评价二次宫腔镜在诊断和治疗术后IUA中的功效。方法550例诊断为IUA、子宫内膜息肉或黏膜下肌瘤的术后自愿接受二次宫腔镜检查的育龄患者为研究对象,分析患者二次宫腔镜结果、并发症发生情况,比较手术前、手术后3个月IUA评分。结果IUA患者中宫腔镜确诊IUA 32例(32.3%),其中镜下松懈28例(87.5%);子宫内膜息肉患者中宫腔镜确诊IUA 21例(13.1%),其中镜下松懈10例(47.6%);黏膜下肌瘤患者中宫腔镜确诊IUA 59例(20.3%),其中镜下松懈32例(54.2%)。IUA、子宫内膜息肉、黏膜下肌瘤术后确诊IUA患者术后3个月IUA评分分别为(5.42±2.63)、(3.21±2.34)、(3.79±2.35)分,均低于术前的(9.15±1.25)、(9.86±1.48)、(9.62±1.53)分,差异均具有统计学意义(P<0.05)。在550例患者中,有7例在初次手术中出现了水电解质紊乱,均为使用葡萄糖膨宫液而出现低钠血症,经过对症处理后痊愈,无需重症监护。无子宫穿孔病例发生。结论IUA是宫腔镜术后的较为常见的并发症,早期二次宫腔镜检查是诊断和治疗新发生的IUA的简便有效的方法,值得临床推广。Objective To evaluate the prevalence of intrauterine adhesion(IUA)developing in women undergoing hysteroscopic resection for intraterine adhesions,endometrial polyps,submucosal fibroids,endometrial polyps or submucosal myoma and test the efficacy of second-look hysteroscopy for diagnosing and treating post-surgical intrauterine adhesions.Methods There were 550 patients of childbearing age who were diagnosed with post-surgical intrauterine adhesions,endometrial polyps or submucosal fibroids who voluntarily received second hysteroscopy as study subjects The results of the second hysteroscopy and the occurrence of complications were analyzed,and the intrauterine adhesion scores before surgery and 3 months after surgery were compared.Results In patients with intrauterine adhesions,32 cases(32.3%)were diagnosed with IUA under hysteroscopy,of which 28 cases(87.5%)received microscopic lysis;in patients with endometrial polyps,21 cases(13.1%)were diagnosed with IUA under hysteroscopy,and 10 cases(47.6%)received microscopic lysis;among patients with submucosal fibroids,59 cases(20.3%)were diagnosed with IUA under hysteroscopy,of which 32 cases(54.2%)received microscopic lysis.3 months after surgery,the intrauterine adhesion scores of IUA patients after surgery for intraterine adhesions,endometrial polyps,submucosal fibroids were(5.42±2.63),(3.21±2.34)and(3.79±2.35)points,which was lower than that before surgery(9.15±1.25),(9.86±1.48)and(9.62±1.53)points,and the difference was statistically significant(P<0.05).Among the 550 patients,7 cases had water and electrolyte disturbances during the initial surgery,all of which were hyponatremia due to the use of dextrose uterine solution,and recovered after symptomatic treatment without intensive care.No cases of uterine perforation occurred.Conclusion IUA is a relatively common complication after hysteroscopy.The early secondlook hysteroscopy is a simple and effective method to diagnose and treat newly-occurring IUA,and it is worthy of clinical promotion.

关 键 词：二次宫腔镜 宫腔粘连 宫腔镜松解 宫腔镜切除 

分 类 号：R713.4[医药卫生—妇产科学]