宫腔镜为主综合治疗在不孕症中的研究

Hysteroscopy-based comprehensive treatment on infertility

目的:宫腔镜下取出宫内异物、分离宫腔粘连、重建宫腔治疗宫腔因素不孕症的最新应用。方法:我们对2009～2010年两年内就诊于妇科门诊的不孕症患者进行宫腔镜检查,对术中发现胎骨等胚物残留、息肉等占位及宫腔粘连的患者进行宫腔镜下异物清除术及宫腔粘连分离术,术后留置Foley双腔球囊导尿管,并宫腔内注入玻璃酸钠3 ml,同时上带铜的金属节育环,补佳乐及黄体酮胶囊人工周期治疗2～3个月。对照组为暂时不愿意接受宫腔镜治疗,单纯宫腔球囊扩张、宫腔留置金属节育器、人工周期治疗的患者。两者均预防感染5～7d。结果:治疗组30例,术后月经量明显增多或闭经者月经复潮28例(93.3%)。治疗后妊娠者17例(56.6%),痛经等其他症状缓解29例(96.6%)。对照组28例,术后月经量明显增多或闭经者月经复潮13例(46.4%)。治疗后妊娠者4例(15%),痛经等其他症状缓解18例(64.3%)。结论:宫腔镜治疗为主的配合球囊及抗粘连生物制剂及人工周期治疗明显优于单纯球囊、人工周期,宫腔镜为治疗宫腔因素性不孕症的金标准。

Objectives： To explore the latest treatment on uterine- related infertility by removing foreign body in uterus with hysterosecopy, separating the adhesions of uterine eavity and reconstructing uterus cavity. Methods： Hysteroscopy was used to check and remove foreign bodies in the uterus of uterine - related infertility patients who came to our gynaecolodgy outpatient clinic for consultation between 2009 and 2010. The patients with intrauterus adhesion received separation surgery. After the operation, we retained the Foley double -lumen balloon urinary catheter in patients＇ body, and injected 3ml sodium hyaluronate into uterine cavity. At the same time, patients were placed with the copper IUD and were treated with two to three months＇ estradiol valerate, progesterone capsules administration. The eontrol group was unwilling to receive hysteroscopic treatment. They were simple treated with balloon dilatation, metal IUD placement and medication therapy. Results： Thirty cases in the treatment group increased the volume of menstruation after the treatment. Twenty - eight patients restored the menstruation of amenorrhea （ 93. 3% ） , 17 patients got pregnant （56.6%） , and 29 cases were relieved from dysmenorrhea and other symptoms （96.6%）. Twenty - eight patients in the control group showed increased volume of menstruation. Recovery of menstruation and amenorrhea was observed in 13 cases （46.4%）. Four patients got pregnant （ 15% ）, and 18 cases relieved their dysmenorrhea and other symptoms （ 64.3% ）. Conclusions： The hysteroscopy - based comprehensive treatment is effective in the treatment of uterine - related infertility when it is combined with the anti adhesion biological agents and menstrual cycle treatment. Hysteroscopy provides a golden rule for the diagnosis and treatment of uterus - related infertility.