宫腔镜刨削系统治疗重度宫腔粘连的效果及影响因素分析  

Hysteroscopic IBS for the treatment of severe intrauterine adhesion:efficacy and influencing factors analysis

作　　者：孙洁芸 陆晓媛 经莉 杨焕 刘莹 丁薇 刘昭 SUN Jieyun;LU Xiaoyuan;JING Li;YANG Huan;LIU Ying;DING Wei;LIU Zhao(Department of Gynecology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221002;Department of Nuclear Medicine,the Affiliated Hospital of Xuzhou Medical University)

机构地区：[1]徐州医科大学附属医院妇科,江苏徐州221002 [2]徐州医科大学研究生院,江苏徐州221004 [3]徐州医科大学附属医院核医学科

出　　处：《徐州医科大学学报》2025年第2期128-133,共6页Journal of Xuzhou Medical University

基　　金：江苏省妇幼保健协会科研项目(FYX202023);徐州市卫生健康委科技项目(XWKYHT20240126)。

摘　　要：目的探讨宫腔镜刨削系统(IBS)在重度宫腔粘连(IUA)中的治疗效果及IBS术后联合不同防粘连方法的疗效。方法回顾性分析2018年1月—2024年5月在徐州医科大学附属医院妇科接受治疗的86例重度IUA患者的临床资料,其中接受宫腔镜IBS手术患者48例(IBS手术组),接受宫腔镜电切术患者38例(电切术组),比较2组患者的相关资料。根据术后预防粘连的方法将IBS手术组患者分为A组(透明质酸钠)、B组(透明质酸钠+雌孕激素)、C组[透明质酸钠+宫内节育器(IUD)+雌孕激素],比较3组患者的临床资料;建立logistic回归模型,分析重度IUA宫腔镜IBS术后治疗效果的影响因素。结果宫腔镜IBS组与宫腔镜电切组患者的年龄、既往流产/宫腔手术次数、术前美国生育协会(AFS)评分、手术时长、手术平均出血量无明显差异(P>0.05);在术后月经量改善方面,IBS手术组治疗重度IUA的总有效率(68.8%)优于电切组(47.4%)(P<0.05)。重度IUA患者宫腔镜IBS术后联合不同防粘连方法的比较,A、B、C 3组患者在年龄、术前AFS评分、手术时长、手术出血量方面差异无统计学意义(P>0.05);在术后月经量改善方面,C组优于A、B组(P<0.05);多因素logistic回归分析显示病程长(>1年)、治疗后内膜厚度薄(厚度内膜≤0.6 cm)是影响重度IUA宫腔镜IBS术后治疗效果的独立危险因素。IBS术后口服雌孕激素、宫腔放置IUD有助于改善症状(P<0.05)。结论宫腔镜IBS治疗重度IUA效果良好,重度IUA术后联合透明质酸钠+宫内节育器+雌孕激素防粘连可提高疗效。Objective To explore the efficacy of hysteroscopic Intrauterine Bigatti Shaver(IBS)in treating severe intrauterine adhesion(IUA)and the therapeutic outcomes of IBS combined with different anti-adhesion methods.Methods Retrospective analysis was conducted on the clinical data of 86 patients with severe IUA who were treated in Department of Gynecology,the Affiliated Hospital of Xuzhou Medical University from January 2018 to May 2024.Among them,48 patients underwent hysteroscopic IBS surgery(IBS group),and 38 patients underwent hysteroscopic electrosurgery(electrosurgery group).The clinical data of the two groups were compared.According to postoperative anti-adhesion methods,the IBS surgery group was further divided into three subgroups:group A(sodium hyaluronate),group B(sodium hyaluronate+estrogen and progesterone),and group C(sodium hyaluronate+intrauterine device(IUD)+estrogen and progesterone).The clinical data of the three groups were compared.A logistic regression model was established to analyze the influencing factors of postoperative efficacy in severe IUA patients treated with hysteroscoptic IBS.Results There were no statistical differences between the IBS group and the electrosurgery group in terms of age,history of abortion/intrauterine surgery,preoperative American Fertility Society(AFS)score,operation duration,and average intraoperative blood loss(P>0.05).In terms of postoperative improvement in menstrual volume,the total effective rate of the IBS group(68.8%)was superior to that in the electrosurgery group(47.4%)(P<0.05).Among the IBS group patients treated with different anti-adhesion methods,there were no significant differences in age,preoperative AFS score,operation duration,or intraoperative blood loss among groups A,B,and C(P>0.05).However,group C showed better improvement in postoperative menstrual volume,compared with groups A and B(P<0.05).Multivariate logistic regression analysis showed that a long disease duration(>1 year)and thin endometrial thickness after treatment(≤0.6 cm)were indepe

关 键 词：宫腔镜 宫腔镜刨削系统 宫腔粘连 透明质酸钠 雌孕激素 宫内节育器 影响因素 

分 类 号：R713.4[医药卫生—妇产科学]