预防子宫纵隔宫腔镜电切术后宫腔粘连的体会  

Experience with Prevention of Intrauterine Adhesion after Hysteroscopic Septum Resection

作　　者：杨仕章 YANG Shi-zhang(Department of Obstetrics and Gynecology,Affiliated Hospital of Jiangnan University,Wuxi 214000,China)

机构地区：[1]江南大学附属医院妇产科,江苏无锡214000

出　　处：《实用临床医学（江西）》2022年第5期30-33,共4页Practical Clinical Medicine

摘　　要：目的 探讨预防子宫纵隔宫腔镜电切术后宫腔粘连的措施。方法 2019年1月至2021年12月60例子宫纵隔施行宫腔镜子宫纵隔切除术(TCRS),术后放置节育器(IUD)30例为A组,放置IUD+口服戊酸雌二醇30例为B组,B组再根据口服戊酸雌二醇每日口服剂量分为B1组(3 mg)10例、B2组(6 mg)8例和B3组(9 mg)12例。术后随访5~48个月。观察各组术后宫腔粘连发生率、月经改善率、妊娠率及自然流产率。结果 随访期间A组和B组月经改善率、妊娠率、宫腔粘连率、自然流产率比较差异无统计学意义(χ^(2)=0.739,P=0.390;χ^(2)=0.268,P=0.605;χ^(2)=3.268,P=0.071;χ^(2)=1.002,P=0.317)。从B1到B3组,月经改善率、妊娠率逐渐升高,宫腔粘连率逐渐下降;B1、B2、B3组自然流产率比较差异无统计学意义(χ^(2)=3.445,P=0.179),B1、B2、B3组宫腔粘连率、月经改善率、妊娠率比较差异有统计学意义(χ^(2)=8.906,P=0.012;χ^(2)=15.000,P=0.001;χ^(2)=13.645,P=0.001)。结论 子宫纵隔宫腔镜电切术后放置IUD同时加服戊酸雌二醇对防止宫腔粘连形成无明显优势;术后每日口服戊酸雌二醇9 mg宫腔粘连及妊娠结局有改善。Objective To investigate the measures to prevent uterine adhesion after hysteroscopic septum resection.Methods Data of 60 patients who underwent transcervical resection of septum(TCRS)between January 2019 and December 2021 were analyzed retrospectively.These patients were postoperatively given intrauterine contraceptive device(IUD)alone(group A,30 cases)or in combination with oral estradiol valerate(group B,30 cases).According to the daily dose of estradiol valerate,the group B was further divided into group B1(3 mg,10 cases),group B2(6 mg,8 cases)and group B3(9 mg,12 cases).Postoperative intrauterine adhesion,menstrual improvement,pregnancy and spontaneous abortion were observed during 5-48 months of follow-up.Results There were significant differences between group A and group B in the rates of intrauterine adhesion(χ^(2)=0.739,P=0.390),pregnancy(χ^(2)=0.268,P=0.605),menstrual improvement(χ^(2)=3.268,P=0.071),and spontaneous abortion(χ^(2)=1.002,P=0.317).However,estradiol valerate treatment dose-dependently increased the rates of menstrual improvement(χ^(2)=8.906,P=0.012)and pregnancy(χ^(2)=15.000,P=0.001),and reduced the incidence of intrauterine adhesion(χ^(2)=13.645,P=0.001).The differences in the incidence of spontaneous abortion were no significant among groups B1,B2 and B3(χ^(2)=3.445,P=0.179).Conclusion IUD placement combined with estradiol valerate has no obvious advantage in preventing intrauterine adhesion after TCRS.Oral estradiol valerate administration at the dosage of 9 mg per day can improve intrauterine adhesion and pregnancy outcome.

关 键 词：宫腔镜 子宫纵隔切除术 子宫纵隔 戊酸雌二醇 宫腔粘连 

分 类 号：R713.4[医药卫生—妇产科学]