不同负压对不全流产以及子宫内膜损伤的影响

Effect of Different Vacuum Pressures on Incomplete Abortion and Endometrial Injuries

目的 通过对自愿终止妊娠的早孕患者应用不同最大负压行人工流产术（人流）的研究,寻求安全有效的措施,以减少对子宫内膜的损伤.方法 选择在武警北京市总队医院门诊因早孕5～7周拟行无痛人流的健康患者877例,胎囊直径在1.0～2.5 cm,随机分为3组：组1共288例,负压最大500 mmHg;组2共291例,负压最大450 mmHg;组3共298例,负压最大400 mmHg;3组均由同一长期从事计划生育手术的高年资主治医师实施手术.术后观察：子宫穿孔、漏吸、术后感染及羊水栓塞;术后出血时间;不全流产率及子宫内膜损伤率.结果 3组患者手术并发症情况比较,3组患者均未发生子宫穿孔、漏吸、术后感染及羊水栓塞,仅组2中有1例因不全流产行二次刮宫术.对可疑内膜损伤的患者进行宫腔镜检查,宫腔粘连（IUA）发生率组1为9.38%,组2为4.48%,组3为0.67%,3组间差异有统计学意义（P＜0.05）.结论 在孕早期实施人工流产术,选择400 mmHg作为最大负压进行吸引,并不增加不全流产的发生率,且能减少对子宫内膜的损伤,值得推广.

Objective To evaluate the safety and efficacy of different vacuum pressures in analgesic surgical abortion for healthy first-trimester women in order to avoid the endometrial damage and reduce the rate of incomplete abortion. Methods A total of 877 healthy first-trimester women who underwent analgesic surgical abortion in Chinese People＇s Armed Police Force Hospital of Beijing were enrolled in the study. The gestational age was 5- 7 weeks and the embryo sac was 1.0- 2.5 cm. Patients were randomly assigned into three groups： group 1,in which 288 women were treated at a maximum pressure of 500 mmHg in analgesic surgical abortion;group 2 ,in which 291 women were subjected to analgesic surgical abortion at a maxi- mum pressure of 450 mmHg;group 3,in which 298 women were treated at a maximum pressure of 400 mmHg. All the opera- tions were performed by the same experienced doctor. The related measures were compared among the groups：uterine perfora- tion, missed suction, postoperative infection, and amniotic fluid embolism, postoperative bleeding time, incidence of incomplete a- bortion and rate of endometrial damage. Results No uterine perforation, missed suction, postoperative infection and amniotic fluid embolism occurred in all 3 groups. A secondary curettage was performed due to incomplete abortion in a patient from the group 2. The rate of intrauterine adhesions was 9. 38% ,4.48% and 0.67% in groups 1,2 and 3, respectively, with statistical significant difference noted（P〈0.05）. Conclusion Vacuum aspiration at a maximum pressure of 400 mmHg does not increase the incidence of incomplete abortion while reducing the endometrial injuries,which is worthy of extensive application.