子宫颈检查在药物流产后出血处理中的作用

Clinical value of cervical examin ation on vaginal bleeding after pharmace utical abortion.

目的 探讨子宫颈检查对处理药物流产后出血中的临床意义和作用。方法 对药物流产后出血超过 15天的患者进行子宫颈外观检查及改良 Insler子宫颈评分 ,子宫颈分泌物涂片镜检查 ,B超检查 ,部分患者行血清生殖激素测定和子宫腔内刮出物的病理检查。结果 5 4.47% (140 / 2 5 7)的患者发现子宫颈管内组织堵塞 ,立即行清宫术止血 ,病理检查证实为子宫腔内组织残留 ,117例改良 Insler子宫颈评分为 6 .2 6± 1.16分 ,5 7例高于 8分 ,占 48.72 % ,2 4.79% (2 9/ 117)的患者子宫颈管内分泌物涂片发现慢性子宫内膜炎 ,83.76 % (98/ 117)的无子宫颈管内组织堵塞的患者应用炔诺酮止血成功 ,19例 (16 .2 4% )用炔诺酮止血失败者清宫发现有绒毛组织残留。结论 对药物流产后出血超过15天的患者应常规进行子宫颈检查 ,子宫颈管内有组织堵塞者应立即清宫 。

Objective To determine the value of cervical examinat i on on vaginal bleeding after mifepriston e and misoprostol abortion.Metho ds Cervical observation and modi fied Insler cervix score,smear examinati on of cervical canal and examination of cavity of uterus with ultrasonography we re carried out in the patients with blee ding duration over 15 days.Serum reprodu ctive hormone was measured by radioimmun oassay and residual tissues in the cavit y of uterus were examined by microscopy in the rest of patients.Results 257 patients with vaginal bleedi ng duration over 15 days after pharmaceu tical abortion were included in this stu dy.Remained embryonic tissues in the ute rine cavity were confirmed by pathologic al examination in 140 patients(54.47%)an d residual tissues blocking the cervical canal were observed.The modified Insler score was 6.26±1.16,and it excecded in 57 patients 48.72%.The chronic end ometritis prevalence was 24.97%(29/117) by cervical canal smear examination.The rate of bleeding stop with oral norethin drone acetate in 3 days, was 83.76%(98/1 17)and curettage was carried out in rema ined cases and residual tissues were fo un d.Conclusion Cervical ex amination should be carried out routinel y in the patients with vaginal bleeding duration over 15 days after pharmaceutic al abortion.Curettage should be immediat ely carried out in patients with cervica l canal tissues blocking.Norethindrone a cetate is an effective agent for the pat ients without residual tissues cervical canal.