宫腔镜下行宫腔粘连导致不孕的手术治疗

Analysis of Asherman Infertility Treated by Hysteroscopy

目的评价宫腔镜联合B超治疗宫腔粘连的安全性和有效性,以及对因宫腔粘连所致不孕患者的妊娠率的改善情况。方法回顾性分析2006年12月—2009年12月在襄樊市中心医院行B超监测下行宫腔镜宫腔粘连切除术(transcervical resection of adhesions,TCRA)的86例因宫腔粘连所致不孕患者的临床资料。结果在B超监测下宫腔镜治疗宫腔粘连的86例患者中,无并发症发生。术后受孕率达58.1%,足月分娩率达70.00%。受孕率高低与以下有关:①宫腔粘连程度轻度粘连者妊娠率最高92.6%(25/27);中度粘连者妊娠率50%(22/44);重度粘连者妊娠率最低2%(3/5),P(0.05,差异有统计学意义。②宫腔粘连类型中央型粘连妊娠率最高90.9%(30/33);周围型与混合型粘连妊娠率无明显差异,分别为39%(16/41)、33.3%(4/12)。③术后处理,宫腔放置气囊尿管者,术后再次粘连发生率低于宫腔放置节育环者,受孕率均高于宫腔放置节育环者,差异有统计学意义。宫腔粘连程度与宫腔操作次数无明显关系,与感染及宫腔操作不当有明显关系。结论宫腔镜联合B超是一种治疗宫腔粘连微创有效的方法,能有效提高因宫腔粘连所致不孕患者的妊娠率。

Objective To evaluate the safety and effectiveness of hysteroscopy joint B - ultrasound in theraphying asherman, and it＇s function in improving patients＇pregnant rate who had asherman infertility. Methods A retrospectively study was carried out to analyse 86 patients datum , who were treated by transcervical resection of adhesions with B - ultrasound monitoring, in the xiangfan center hospital ,from 2006.12. to 2009.12. Results In 86 patients who were treated with transcervical resection of adhesions with B - ultrasound monitoring, no complications occurred. In 86 patients, the pregnant rate after operation was 58.1% , the delivery rate was 70.00%. These were related factors of pregnant rate：①The degree of asherman. The pregnant rate of patients with mild adhesion was 92.6% （25/27）; The pregnant rate of patients with moderate adhesion was 50% （22/44）; And the pregnant rate of patients with severe adhesion was 2% （3/5）, The difference had statistical significance. ②The asherman type. The pregnant rate of patients with central adhesions was 90. 90% （30/33）, The pregnant rate between peripheral adhesions and mixed adhesions had no significanct difference, which the pregnant rate is 39 % （ 16/41 ） vs 33.3 % （4/12 ）. ③Postoperative treatment. The recurrence rate is lower in patients who used Foley catheter compare to the patients who used IUD . And the Foley catheter group has higher pregnant rate, the difference had statistical significance. The degree of asherman had no significant correlation with the number of intrauterine operation, while it had significant correlation with infection and improper intrauterine operation. Conclusion Hysteroscopy joint Bultrasound is a minimally invasive and effective method in theraphying asherman, and it can improve pregnant rate of patients who have asherman infertility.