中重度宫腔粘连电切术后辅以人工周期治疗临床疗效观察

Clinical Efficacy of Severe IUA with Transcervical Resection and Artificial Cycle Treatment

【目的】通过综合分析我院收治的中重度宫腔粘连患者临床预后资料,评价中重度宫腔粘连宫腔镜电切术后辅以人工周期预防再粘连方案的临床疗效。【方法】选择经临床确诊的重度宫腔粘连共72例(中度宫腔粘连44例,重度宫腔粘连28例)于宫腔镜下宫腔粘连电切术后予人工周期治疗,临床随访9 mg/d雌激素人工周期治疗的有效性及安全性,及中重度宫腔粘连术后治愈率等临床预后。【结果】宫腔粘连电切术后辅以人工周期治疗3个月后子宫内膜厚度较术前增厚,但仍均较正常对照组薄;中度宫腔粘连患者临床预后优于重度宫腔粘连患者。【结论】宫腔粘连电切分离术后辅以人工周期治疗方案是有必要的,且9 mg/d的雌激素用量是相对安全、有效的。宫腔粘连术后其子宫内膜厚度较术前增厚,但仍未能达正常范围,临床疗效尚欠满意。宫腔粘连患者的临床预后与其术前宫腔病变程度、范围及残存子宫内膜面积及生长情况等相关。

[Objective ]To analyze the clinical outcome of the severe intrauterine adhesions, to investigate clinical efficacy of severe IUA with transcervical resection and artificial cycle treatment. [Methods] A total of 72 cases which diagnosed severe intrauterine adhesion （44 cases with degree-IV intrauterine adhesions, the other 28 with degree V） were collected in our research. After transcervical resection of adhesions, we followed-up the IUA patients to investigate the safety and efficacy of 9 mg/d estrogen artificial cycle. [Result] 9 mg/d estrogen artificial cycle after surgery was safe and effective for IUA patients. After post-operation artificial cycle treatment the IUA endometrium were thicker, but still not satisfactory. The treatment of intrauterine adhesion improves reproductive outcome obviously, which depends on the nature, degree and scope of adhesions.