宫腔镜治疗宫腔粘连所致月经异常疗效相关因素分析

The factors that affect the efficacy of hysteroscope in the treatment of abnormal menstruation caused by intrauterine adhesions

目的探讨宫腔镜治疗由宫腔粘连所致月经异常疗效的相关因素。方法对2008年1月至2012年1月广西医科大学第一附属医院112例因月经异常并经宫腔镜证实有宫腔粘连的患者行宫腔粘连分离术,术后行3个月激素治疗,观察术后第3个月的月经恢复情况,并对治疗有效组和无效组患者进行年龄、症状、术前内膜厚度、病因、宫腔操作次数、病程时间、宫腔形态、术中内膜情况、粘连程度、宫腔重建满意程度、激素治疗后内膜厚度这11个变量的差异进行比较,对与疗效可能相关的因素进行分析。结果治疗有效组83例(74.1%),无效组29例(25.9%)。单因素分析显示年龄、症状、术前内膜厚度、病程时间、内膜形态、粘连程度、宫腔操作次数、宫腔重建满意程度、人工周期后内膜厚度9个因素与疗效有关。将9个有意义的变量进行多因素非条件Logistic回归分析,提示只有激素治疗后内膜厚度与疗效直接相关。结论宫腔镜下宫腔粘连分离术加激素治疗后子宫内膜厚度是与疗效相关的主要因素。

Objective To investigate the factors that affect the efficacy of hysteroscopic transcervical resection of adhesion（TCRA） in the treatment of abnormal menstruation caused by intrauterine adhesions.Methods 112 patients who had abnormal menstruation with intrauterine adhesions diagnosed by hysteroscopy underwent transcervical resection of adhesion.After surgery,all patients were given hormone therapy for 3 months,and then observe the restoration of the menstruation in the third month.The symptoms,endometrial thickness before the operation,etiology,the number of intrauterine operation,disease time,the shape of uterine cavity,the feature of endometrium,the degree of intrauterine adhesions,the restoration of uterine cavity,age and the endometrial thickness after hormone replacement therapy were analyzed.Results Out of these 112 patients,effective treatment 83 cases（74.1%）,ineffective treatment 29 cases（25.9%）.These 11 parameters evaluated with univariate analysis respectively,only the endometrial thickness after hormone therapy went into regression equation as the most important factor that affects the efficacy.Conclusions Intrauterine operation is the main cause of intrauterine adhesions.The endometrial thickness after hormone therapy is the main factor that affects the efficacy of TCRA in the treatment of abnormal menstruation caused by intrauterine adhesions.