影响宫腔镜下宫腔粘连分离术为主综合治疗疗效相关因素分析

Analysis of the relative factors affecting the outcome of comprehensive management of intrauterine adhesions

目的 :探讨影响宫腔镜下宫腔粘连分离术为主综合治疗疗效的相关因素。方法:回顾分析2010年7月至2012年3月在温州医学院温州市第三临床学院收治的112例因不孕就诊的宫腔镜下分离术为主综合治疗的宫腔粘连患者的临床资料,根据术后第3周期雌孕激素序贯治疗撤退出血后宫腔镜二次探查结果分为三组。治愈组(n=62):月经恢复,由无到有,由少到多,宫腔形态正常,宫腔镜下见双侧宫角与输卵管开口;有效组(n=26):月经恢复,但月经量仍少,宫腔形态基本正常,宫腔镜下未见双侧宫角与输卵管开口,但宫腔形态基本恢复;无效组(n=24):月经未恢复,术后宫腔再粘连。比较三组的临床特点,分析影响宫腔粘连分离术预后的相关因素。结果:①不孕年限、术前月经情况比较:不孕年限两两比较无效组([5.02±1.80)年]明显高于治愈组[(2.30±1.02)年]和有效组([3.00±1.44)年],差异有统计学意义(P<0.05)。三组术前闭经率比较差异有统计学意义(P<0.05),无效组为66.7%(16/24),高于治愈组的14.5%(9/62)和有效组的30.8%(8/26)。②术中情况比较:三组粘连范围、粘连性质存在显著相关(P<0.01)。粘连范围>3/4两两比较无效组高于治愈组及有效组(P<0.01)。单侧宫角封闭及子宫下段粘连三组之间无明显差异(P>0.05)。双侧宫角封闭、子宫上段封闭三组比较,差异有统计学意义(P<0.01)。结论:不孕年限、术前月经情况、宫腔粘连范围、粘连性质、粘连的部位、宫角封闭情况与宫腔镜下宫腔粘连分离术为主综合治疗疗效有一定关系。

Objective： To explore the relative factors affecting the outcome of comprehensive management of intrauterine adhesions. Methods： A retrospectively study of the 112 cases of hysteroscopic lysis of intrauterine adhesions （IUA） due to infertility in our hospital from July 2010 to Mar 2012 was conducted. All these were divided into three groups according to the outcome of second look hysteroscopy examinations after three consecu- tive withdrawal vagina/bleeding. Cure group （n=62）： menstruation recovered, and uterine cavity was normal, the bilateral horns and uterine opens of fallopian tubes could be seen. Effective group （n=26）： menstruation recovered but the amount was still less, and uterine cavity was normal roughly but the horns, uterine opens of fallopian tubes could not be seen yet. Ineffective group （n=24）： menstruation hadn＇t recovered, adhesions appeared again. To compare the clinical characteristics of three groups, then the relative factors affecting the outcome of Hystero- scopic lysis of IUA were analyzed. Results： O） Infertility time and preoperative menstruation characteristics： Pairwise comparisons indicated it was longest infertility time in ineffective group than that in the other two groups （P〈0.05）. Amenorrhea rate was significant different （P〈0.05）. Intraoperative condition： compari- sons were conducted in three groups on type of adhesions and extent of cavity involved, which existed significant relevance （P〈0.01）. It was highest in ineffective group than the other two groups regarding extent