重度宫腔粘连多次行宫腔镜下粘连分离术后妊娠1例报道  

A case report of pregnancy after repeated hysteroscopic adhesiolysis for severe intrauterine adhesion

作　　者：曾昭恺 郭子泽 叶黔 ZENG Zhaokai;GUO Zize;YE Qian(Department of Gynecology and Obstetrics,Nanping First Hospital Affiliated to Fujian Medical University,Fujian Province,Nanping 353006,China;Department of Gynecology and Obstetrics,Fujian Maternal and Child Health Hospital,Fujian Province,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属南平第一医院妇产科,福建南平353006 [2]福建省妇幼保健院妇产科,福建福州350001

出　　处：《妇儿健康导刊》2022年第4期43-46,F0004,共5页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

摘　　要：宫腔内粘连(IUA)是各种原因引起子宫内膜受损、纤维化,导致子宫内膜、子宫肌层和子宫颈管部分或全部粘连,引起患者月经周期及月经量异常、腹痛、流产、早产或继发性不孕的一类妇科常见疾病,严重危害女性的生殖健康。宫腔镜宫腔粘连分离术(HA)是临床有效的治疗手段,能一定程度提高患者术后妊娠率,但作为一种有创操作,其或将二次损伤子宫内膜,加重术后粘连及继发性不孕。本文报告1例孕5月余因死胎引产,胎盘残留行清宫术患者,术后重度IUA,保守治疗无效后行4次HA,术后妊娠。本文同时对提高HA后妊娠率的文献进行复习,认为重度IUA保守治疗无效,经多次HA辅以术后防宫腔再粘连护理,仍可获较高妊娠机会。Intrauterine adhesion(IUA)is a common gynecological disease caused by various causes of endometrial damage and fibrosis,resulting in part or all layer of adhesion in endometrium,myometrium and cervical canal which lead to abnormal menstrual cycle and volume,abdominal pain,miscarriage,premature birth or secondary infertility and seriously endanger women’s reproductive health.Hysteroscopic adhesiolysis(HA)is an effective clinical treatment to improve post-operative pregnancy rate,but as an invasive procedure,it may bring secondary damage to endometrium,aggravate post-operative adhesion and generate secondary infertility.This paper reported a case of induced labor and uterine curettage due to stillbirth and placenta residue with more than 5 months of gestation.Four times of HA after conservative treatment failed,the patient got pregnant.At the same time,this study reviews the literature on improving the pregnancy rate after HA,and concludes that when conservative treatments are proved ineffective in severe IUA,there are still high pregnancy chances after receiving multiple HA an d post-operative anti-intrauterine adhesion nursing.

关 键 词：宫腔内粘连 宫腔镜宫腔粘连分离术 子宫内膜 妊娠 

分 类 号：R713.4[医药卫生—妇产科学]