宫腔镜不同术式联合药物治疗子宫纵隔临床结局分析  

Clinical analysis of different hysteroscopic methods combined with drugs in the treatment of uterine septum

作　　者：杨仕章 许希中[1] YANG Shizhang;XU Xizhong(Department of Obstetrics and Gynecology,Affiliated Hospital of Jiangnan University,Wuxi 214000,Jiangsu,China)

机构地区：[1]江南大学附属医院妇产科,江苏无锡214000

出　　处：《中国现代医生》2024年第5期62-66,共5页China Modern Doctor

摘　　要：目的探讨宫腔镜不同术式治疗子宫纵隔的临床结局。方法回顾性分析2020年1月至2022年1月90例子宫纵隔施宫腔镜治疗纵隔子宫效果;将患者分为电切组45例,冷刀组45例,两组术后随机使用雌孕激素序贯治疗和宫腔用交联透明质酸钠凝胶加口服雌孕激素序贯治疗,分析比较两组手术时间、术中出血量,通过二探观察两组子宫纵隔残留、宫腔粘连、妊娠率、自然流产率的情况。结果90例患者均完成手术,无子宫穿孔、水中毒、感染及大出血等并发症发生。总的平均手术时间(20.3±6.8)min,平均出血量为(11.2±3.1)ml,住院时间1.0~5.0d。电切组、冷刀组比较手术时间、术中出血量、纵隔残存、宫腔粘连、妊娠率、流产率、差异无统计学意义(P>0.05)。电切组、冷刀组比较单纯雌孕激素序贯治疗宫腔粘连、妊娠率差异无统计学意义(P>0.05),流产率差异有统计学意义(P<0.05);电切组、冷刀组比较联合使用宫腔用交联透明质酸钠凝胶加口服雌孕激素序贯治疗宫腔粘连、妊娠率、流产率差异无统计学意义(P>0.05)。结论宫腔粘连、纵隔残存与切除方式没有明确相关性,术后使用宫腔用交联透明质酸钠凝胶加口服雌孕激素序贯治疗有利于降低粘连率和流产率。Objective To investigate the uterine septum clinical treatment effects by hysteroscopy different ways of excision.Methods The treatment effects of 90 uterine septum cases were analyzed retrospectively.Those patients were divided into two groups,One group 45 cases accepted hysteroscopy electrosurgical excision,Another group 45 cases was implemented uterine septum cut off with hysteroscopic miniature scissors.Their operative time,blood loss were recorded and compared,and their mediastinal residual and intrauterine adhesions were retreated again in second hysteroscopy checking after 3 months of the first opration.Results All cases were finish the operation sccssefly without complication happens.The total average surgical time was(20.3±6.8)minutes,the average bleeding volume was(11.2±3.1)ml,and the hospital stay was 1 to 5 days,average of 3.5 days.There was no significant difference between the electric resection and cold knife groups in operation time,intraoperative bleeding,mediastinal residual,uterine cavity adhesion,pregnancy rate and abortion rate(P>0.05).There was no significant difference between the two groups in the sequential treatment of intrauterine adhesions and pregnancy rates with simple estrogen and progesterone(P>0.05),the difference of abortion rate was statistically significant(P<0.05).There was no significant difference between the two groups in the sequential treatment of intrauterine adhesion,pregnancy rate and abortion rate with the combination of intrauterine cross-linked sodium hyaluronate gel and oral estrogen and progesterone(P>0.05).Conclusion There was no clear correlation at intrauterine adhesions,mediastinal remnants in resection methods.The sequential treatment of intrauterine cross-linked sodium hyaluronate gel plus oral estrogen and progesterone after operation is conducive to reducing the adhesion rate and improving the pregnancy rate.

关 键 词：宫腔镜 子宫纵隔 交联透明质酸钠凝胶 

分 类 号：R713[医药卫生—妇产科学]