宫腔镜检查及宫腔直视下负压吸引术在合并宫腔粘连的人工流产中的应用效果  

作　　者：钱焕 高磊磊 

机构地区：[1]浙江省湖州市第一人民医院,313000 [2]浙江省人民医院,310000

出　　处：《浙江临床医学》2024年第12期1782-1783,共2页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金青年项目(82001539)。

摘　　要：目的探讨宫腔镜检查及宫腔直视下负压吸引术在并宫腔粘连史患者中的应用效果。方法选取2020年6月至2023年6月超声显示宫腔粘连的人工流产患者120例,根据患者治疗意愿分为对照组(行传统负压吸引人工流产术)、宫腔镜组(宫腔镜检查+负压吸引人工流产+宫腔粘连分离术)及可视组(行宫腔直视下负压吸引术)各40例,术后予戊酸雌二醇及地屈孕酮人工周期法口服,比较术后2周两组患者手术效果、术后阴道流血时间、月经复潮情况、术后第一次转经后子宫内膜变化情况及术中术后并发症。结果三组患者胚物残留率、宫腔粘连情况、术后子宫内膜厚度、术后第一次转经后子宫内膜厚度、手术时间比较,差异有统计学意义(P<0.05);三组患者术中及术后并发症比较,差异无统计学意义(P>0.05)。结论宫腔镜检查及宫腔直视下负压吸引术对于宫腔粘连合并人工流产患者是安全、有效的手术方式,能显著减少胚物残留的概率;宫腔镜术中可同时行宫腔粘连分离术,促进宫腔粘连及内膜厚度的恢复。Objective To explore the role and efficacy of hysteroscopy and negative pressure suction under direct uterine vision in patients with a history of intrauterine adhesion.Methods A total of 120 cases of induced abortion patients with intrauterine adhesion shown by ultrasound in Huzhou First People's Hospital and Zhejiang Provincial People's Hospital from June 2020 to June 2023 were selected.According to the patients'treatment intention,they were divided into the control group(traditional negative pressure suction induced abortion),the hysteroscopy group(hysteroscopy+negative pressure suction induced abortion+intrauterine adhesion separation)and the visual group(hysteroscopy+negative pressure suction under direct vision),with 40 cases in each group.After operation,estradiol valerate and dydrogesterone were given by artificial cycle.The surgical effect,postoperative vaginal bleeding time,menstrual recovery,endometrial changes after the first postoperative conversion and intraoperative and postoperative complications were compared between the two groups 2 weeks after the operation.Results There were significant differences among the three groups in embryo residue rate,intrauterine adhesion,postoperative endometrial thickness,endometrial thickness after the first postoperative menstrual transition,and operation time(P<0.05).There was no significant difference in intraoperative and postoperative complications among the three groups(P>0.05).Conclusion Hysteroscopy and negative pressure suction under direct vision are safe and effective surgical methods for patients with intrauterine adhesion combined with induced abortion,which can significantly reduce the probability of embryo residue.Separation of intrauterine adhesions can be performed at the same time during hysteroscopy to promote the recovery of intrauterine adhesion and endometrial thickness.

关 键 词：人工流产 宫腔粘连 宫腔镜检查 临床疗效 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]