以宫腔镜手术为主的综合治疗在宫腔粘连性不孕中的应用

Combined Therapy with a Primary of Hysteroscopy in Intrauterine Adhesion of Infertile Cases

目的:探讨以宫腔镜手术为主的综合治疗在宫腔粘连性不孕中的应用价值。方法:回顾性分析67例宫腔粘连患者的治疗效果,均经宫腔镜下机械性粘连分离术及输卵管间质部插管通液术,术后宫腔放置宫内节育器及雌、孕激素周期治疗。结果:67例宫腔粘连中轻度粘连24例,中度粘连25例,重度粘连18例。46例1次手术成功重建宫腔,21例2次手术。术后88.1%宫腔形态正常,79.1%月经恢复正常,输卵管通畅率72.1%。术后妊娠率50.7%,活产率85.3%。无手术并发症。结论:宫腔镜对于不同程度宫腔粘连的宫腔重建微创、有效。术中注意保护子宫内膜;疏通阻塞的输卵管对提高妊娠率至关重要。

Objective：To approach the value of combined therapy with a primary of hysteroscopy in intrauterine adhesion of infertile cases.Methods：In a retrospective study,67 infertile patients with intrauterine adhesions were separated intrauterine adhesions mechanically and oviduct intubation,who were treated with IUD-installed and manpower-cycle after operation.Results：Intrauterine adhesion with mild,moderate and severe grade were found in 24 cases,25 cases and 18 cases,respectively.Forty-six cases were detached completely in once operation and 21 cases was operated twice.After the operation,the rate of normal uterine cavity was 88.1%.The rate of tubal patency rate was 72.1%.The rate of normal menstruation was 79.1%.The pregnancy rate after operation was 50.7% and the live delivery rate was 85.3%.There were no operative complications in the study.Conclusion：It is microtraumatic and effective for patients with different degree of intrauterine adhesion to choose hysteroscopy in re-establish of uterine cavity.It is important to protect endometrium and treat tubal obstruction by the hysteroscopic oviduct intubation in order to improve pregnant rate.