宫腔镜诊治妊娠组织物残留40例临床研究  

Clinical study of hysteroscopic diagnosis and treatment of 40 cases with retained products of conception

作　　者：许锋[1] 王素敏[1] 贾雪梅[1] 顾小燕[1] Xu Feng;Wang Sumin;Jia Xuemei;Gu Xiaoyan(Department of Gynecology,the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University(Nanjing Maternity and Child Health Care Hospital),Nanjing Jiangsu 210004,P.R.China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)妇科,江苏南京210004

出　　处：《中国计划生育和妇产科》2025年第2期94-97,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨应用宫腔镜手术治疗妊娠组织物残留的临床有效性和安全性。方法选择2022年1月至2024年6月在南京医科大学附属妇产医院诊治的40例妊娠组织物残留患者,分为Ⅰ组无血流异常组(21例)及Ⅱ组血流异常组(19例),回顾性分析其临床资料及术后随诊情况。结果两组患者平均年龄、残留妊娠物宫腔内滞留时间、术前血β-hCG值及超声团块最大直径差异均无统计学意义(P>0.05)。所有患者均在静脉全麻下采用宫腔镜手术去除宫腔残留妊娠组织物。两组手术时间及膨宫液使用量比较差异有统计学意义(P<0.05)。两组经宫腔镜一次性完全清除残留妊娠物的治愈率均为100%,无子宫穿孔、大出血、TURP(trans-urethral resection of prostate)综合征等并发症发生。月经复潮时间为术后2~6周,月经量较术前均无明显减少。术中同时诊治14例合并宫腔粘连,1例合并子宫不全纵隔,15例患者均在术后2个月宫腔镜二探,再次宫腔镜手术率37.5%(15/40),均未发现再次宫腔粘连或残余纵隔。结论宫腔镜手术可直视下完全清除残留妊娠物,并对并存的宫腔粘连或子宫纵隔等宫内疾病即诊即治;且在宫腔镜术中使用冷环技术可避免宫腔粘连的发生。宫腔镜手术治疗妊娠组织物残留安全、有效,利于保护女性生育力。Objective To investigate the clinical efficacy and safety of hysteroscopic surgery for the treatment of retained products of conception(RPOC).Methods The clinical diagnosis and treatment data and postoperative follow-up of 40 patients with RPOC treated in the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University from January 2022 to June 2024 were retrospectively studied,and they were divided into groupⅠ(no abnormal blood flow,21 cases)and groupⅡ(abnormal blood flow,19 cases).Results There were no significant differences in age,intrauterine RPOC retention time,preoperative bloodβ-hCG value and maximum diameter of ultrasound mass between the two groups(P>0.05).All patients underwent hysteroscopic surgery to remove RPOC under general intravenous anesthesia.There were significant differences in operation time and the amount of distension fluid used between the two groups(P<0.05).The curative ratio of hysteroscopic complete removal of residual pregnancy in both groups was 100%,and no complications such as uterine perforation,massive hemorrhage,trans-urethral resection of prostate(TURP)syndrome were occurred.The time of menstrual recurrence was 2~6 weeks after surgery,and the amount of menstruation was not significantly reduced.During the operation,14 cases with intrauterine adhesions and 1 case with incomplete uterine septum were treated,hysteroscopy examination was performed for the second time in 15 cases in 2 months after surgery.The rate of re-hysteroscopic surgery was 37.5%(15/40),and no recurrent intrauterine adhesions or residual uterine septum were found.Conclusion Hysteroscopic surgery can completely remove RPOC under direct vision,and diagnose and treat coexistent intrauterine diseases such as intrauterine adhesions or uterine septum simultaneously.Hysteroscopic cold ring technique avoids the occurrence of intrauterine adhesions.Hysteroscopic surgery is a safe and effective technique for the treatment of retained products of conception,which is conducive to the protection of femal

关 键 词：妊娠组织物残留 宫腔镜 宫腔粘连 

分 类 号：R714.46[医药卫生—妇产科学]