目的 探讨和分析中重度宫腔粘连患者综合治疗效果。方法 回顾性分析2011-04至2014-04在首都医科大学附属北京天坛医院妇科进行治疗,有生育要求并完成随访的综合治疗的中重度宫腔粘连患者共75例,分析其月经模式、宫腔粘连程度、宫腔镜二次探查中再粘连的发生率与妊娠的相关性及治疗后的妊娠分娩结局。结果 75例平均年龄(32.1±5.1)岁,中度粘连47例,重度粘连28例,月经模式改善率为78.7%,总妊娠率为61.3%,中、重度粘连患者的妊娠率分别为76.6%、35.7%,两者有统计学差异(P<0.05)。妊娠率与治疗前的月经模式无关(P>0.05),但与治疗后月经模式有关(P<0.05),logistic回归分析结果显示术前宫腔粘连程度和术后月经模式为影响妊娠的独立危险因素。宫腔镜二次探查及三次探查时发现粘连再形成率为50%,且中、重度粘连患者间的粘连再形成率有统计学差异(P<0.05)。术中发生TURP综合征3例,发生率为2.7 %,均及时发现并救治成功。结论 术前宫腔粘连程度及术后月经模式是影响宫腔粘连患者妊娠结局的独立危险因素,中、重度宫腔粘连的患者预后是有差别的,综合治疗的方法能够为中重度宫腔粘连患者提供更好的临床治疗结局。
Abstract
Objective To introduce an integrated therapy for women with moderate and severe intrauterine adhesion (IUA) and evaluate its reproductive outcome.Methods Seventy-five patients with IUA who had expected fertility and received an integrated therapy were retrospectively studied. The correlation of menstrual pattern, adhesion degree and adhesion reformation with the conception rate were analyzed.Results The mean age of these patients was (32.1±5.1) years old. The improvement rate of menstrual pattern was 78.7 %. The overall conception rate was 61.3 %. The conception rate was 76.6% for those with moderate IUA and 35.7% for severe cases of IUA (P<0.05). Logistic regression analysis showed that the preoperative adhesion degree and postoperative menstrual pattern were independent risk factors for pregnancy. The adhesion reformation rates during the second and third hysteroscopy were both 50%. There was significant difference in the adhesion reformation rate between moderate and severe cases of intrauterine adhesion(P<0.05). There were three (2.7%) cases of TURP syndrome during operation, which were quickly discovered and rescued.Conclusions The adhesion degree and menstrual pattern are independent risk factors for pregnancy, This integrated therapy can ensure better clinical effect for moderate and severe IUA patients, especially in restoring menstrual function and fertility.
关键词
宫腔粘连 /
Asherman综合征 /
宫腔镜 /
粘连分解术
Key words
intrauterine adhesion /
asherman’s syndrome /
hysteroscopy /
adhesiolysis
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基金
首都临床特色应用研究(Z131107002213082)
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