宫腔镜诊治早孕流产术后月经异常90例临床分析

Hysteroscopic diagnosis and therapy for abnormal uterine bleeding after early pregnancy abortion--analysis of 90 cases

目的探讨早孕流产术后月经异常患者及时进行宫腔镜检查的重要性。方法对首都医科大学附属复兴医院自2007年12月～2008年10月间收治的早孕流产后月经异常患者共90例行宫腔镜检查,对在宫腔镜检查中发现有手术指征者行相应的宫腔镜手术。结果90例患者中子宫粘连共47例(52.22%),其中宫腔粘连28例,宫颈粘连6例,宫腔及宫颈均粘连13例。子宫内膜炎3例,结合宫腔镜检查以及病理检查报告支持子宫内膜炎诊断。子宫不全中隔4例(4.44%),其中合并胚物残留者2例。胚物残留17例,检查同时吸宫完全清除胚物患者2例,需TCRF术者15例。宫腔粘连与胚物残留同时存在者4例(4.44%)。正常宫腔者15例(16.66%)。所有患者宫腔镜检查前行B超检查,发现宫内异常者52例,其中宫腔镜检查证实宫内胚物残留、凝血块或子宫畸形者为47例(90.38%),另5例(9.61%)检查中发现宫内未见异常。B超检查未提示异常者为38例,宫腔镜检查发现宫内未见异常者为10例(26.32%),宫腔镜发现宫内异常者为28例,即假阴性率为73.68%。结论宫腔镜检查对于早孕流产术后月经异常患者具有极高的诊断价值,宫腔镜检查同时还可以对部分患者宫腔内病变进行治疗。

[ Objective ] To investigate the importance of early implementation of hysteroscopy for patients with menstrual abnormalities after early abortion. [ Methods ] Totally 90 patients with menstrual abnormalities after early abortion from Dee 2007 to Oct 2008 were enrolled. The patients underwent hysteroseopy and corresponding surgery if indication for operation was available during hysteroseopy. [ Results ] Forty-seven （52.22%） patients had uterine adhesion, including intrauterine adhesion （28 cases）, cervical canal adhesion （6 cases）, and intrauterine and cervical canal adhesion （13 cases）. Three patients were confirmed to have endometritis by hysteroscopy and pathology. Four （4.44%） patients had incomplete uterine septum, of which, 2 patients were complicated with fetal residue. 17 patients were with embryo residue, of which, fetal residue was completely cleared in 2 cases through vacuum aspiration during hysteroscopy and the remaining 15 patients needed TCRF. Intrauterine adhesion complicated with remaining fetus was observed in 4 （4.44%） patients. A total of 15 （16.66%） patients were found to have normal uterus. All the patients received B uhrasonie investigation prior to hysteroscopy, 52 patients were found to have abnormalities by B ultrasonography; of which, 47 （90.38%） cases were confirmed to have remaining fetus, blood clot or uterine malformarion by hysteroseopy, the remaining 5 （9.61%） cases were normal by hysteroseopy. Of 38 eases with normal result by B ultrasonography, 28 （73.68%） were proved by hysteroscopy to have intrauterine abnormalities, 10 （26.32%） patients were normal by hysteroscopy. [ Conclusion ] There is very high diagnostic value of hysteroscopy for abnormal menstruation in patients with early abortion;, meantime, hysteroscopic therapy can be applied if any abnormalities suitable for hysteroscopic surgery are found during hysteroscopic diagnosis.