目的 探讨宫腔镜联合B超对难治性宫腔残留的清除效果。方法 难治性宫腔残留(病程达2个月以上, 反复多次清宫)患者82例, 随机分为3组行清宫术, 宫腔镜联合B超(联合组)32例, 超声监视下清宫(超声组)28例, 宫腔镜辅助下清宫(宫腔镜组)22例。对3组患者的手术时间、术中出血量、术后阴道流血时间、月经恢复情况进行比较。结果 联合组手术时间[(16.2±3.5)min]短于超声组[(26.6±7.8)min]和宫腔镜组[(26.1±5.6)min], 差异均有统计学意义(P＜0.05)。联合组术中出血量[(22.1±8.5)ml]少于超声组[(48.8±20.1)ml]和宫腔镜组[(38.3±14.7)ml], 差异均有统计学意义( P＜0.05)。手术结束时镜下所见, 子宫内膜受累程度依次为超声组、宫腔镜组和联合组。术后阴道流血时间、月经恢复情况等方面, 3组之间比较无统计学差异。超声组术后发生宫腔粘连1例。结论 在难治性宫腔残留的治疗中, 宫腔镜联合B超能明确宫腔内残留物的情况并判断手术的难易程度, 能彻底清除宫腔残留物, 内膜损伤程度轻, 手术时间短, 出血少, 并可避免发生严重并发症。

Objective To study the clinical value of hysteroscopy combined with ultrasound in the diagnosis and treatment of intractable intrauterine residue. Methods From Jan wary 2011 to May 2014 82 patients with refractory intrauterine residue (duration of 2 months above, curettage repeatedly), were randomly divided into three groups. The hysteroscopy combined with ultrasound group (joint group) consisted of 32 patients. 28 patients in the same period with curettage under ultrasound monitoring were assigned to ultrasound group, Hysteroscopy assisted 22 patients served as hysteroscopy group. Operation time, intraoperative blood loss, postoperative vaginal bleeding time, and menstrual recovery were compared between the three groups. Results Operation time in joint group [(16.2±3.5) min] was shorter than that in ultrasound group [(26.6±7.8)min] or hysteroscopy group [(26.1±5.6)min], the differences were statistically significant(P＜0.05). Intraoperative blood loss in joint group [(22.1±8.5)ml] was less than that in ultrasound group [(48.8±20.1)ml] or hysteroscopy group [(38.3±14.7)ml], the differences were statistically significant (P<0.05). Times of menstruation recovery and vaginal bleeding after surgery were not different between the three groups. 1 case in ultrasound group developed intrauterine adhesions. Conclusions In the diagnosis and treatment of refractory intrauterine residue, hysteroscopy combined with ultrasound can make clear intrauterine residue and judge the ease or difficulty of operation, the intrauterine residue can be thoroughly removed, operating time is short with less bleeding, and severe complications can be avoided.