宫腔操作对育龄女性的影响

Influence of uterine cavity operation on women of child-bearing age

目的探讨宫腔操作是否对育龄女性产生不利的影响。方法对2012年6月至2013年5月于我院生殖中心就诊并进行宫腔镜检查的不孕症患者,经入选和排除标准后,最终有370例纳入数据分析;按照宫腔操作史种类分为无任何宫腔操作史者(A组)、有过除人工流产(人流)外的其他宫腔操作史者(B组)、两者均有者(C组)及只有过人流者(D组),比较这四组不孕患者宫腔镜检查结果及月经变化情况;按照月经量变化情况分为月经量未变化组和月经量改变组,并比较这两组宫腔镜下宫腔异常的发生率。从370名入选者中按照宫腔操作次数分别抽取60例无任何宫腔操作史者(a组)、60例有宫腔操作史但总的宫腔操作次数≤3者(b组)和60例总的宫腔操作次数≥4者(c组),比较a、b、c三组患者宫腔镜下宫腔异常的发生率。结果人流组(D组)宫腔异常的发生率显著高于无宫腔操作史组(A组)和无人流的宫腔操作组(B组)(P<0.05);有人流史组(C、D组)宫腔镜下输卵管开口均可见的比例明显低于无宫腔操作史组(A组)和无人流的宫腔操作组(B组)(P<0.05),而C、D两组宫腔镜下输卵管开口均未见的比例明显高于无宫腔操作史组(A组)(P<0.05);人流组(D组)月经量变化的发生率显著高于其他各组(P<0.05),宫腔操作组(B、C、D组)月经量减少的比例高于无宫腔操作组(A组)(P<0.05),D组也高于B组(P<0.05);月经有变化组的宫腔内异常发生率显著高于经量未变化组(P<0.05),经量减少组亦高于经量未变化组(P<0.05);无宫腔操作史者(a组)宫腔异常的发生率低于宫腔操作次数≥4者(c组)(P<0.05)。结论宫腔操作尤其是人工流产术会对女性的子宫内膜造成严重的损伤并影响到输卵管开口。育龄女性应尽量避免宫腔手术尤其是人工流产术。

Objective：To investigate whether uterine cavity operation has negative effects on the women of childbearing age.Methods：A total of 370 patients with infertility,who underwent hysteroscopy examination and accord with inclusion criterion,were recruited in our hospital reproductive center from June 2012 to May 2013.According to the types of uterine cavity operation history,the patients were divided into four groups：group A without any history of uterine cavity operation,group B with other uterine cavity operation history except induced abortion,group C with both histories above,group D with induced abortion history only.The hysteroscopy examination results and menstrual changes were compared among the four groups.According to the menstrual volume,the patients were divided into two groups,i.e.menstrual volume unchanged group and changed group,and the incidence of abnormal uterine cavity under hysteroscopy was compared between the two groups.One hundred eighty patients were selected from 370 patients according to the number of uterine cavity operation frequency：60patients without any history of uterine cavity operation（group a）,60 patients with uterine cavity operation≤3（group b）,and 60 patients with the frequency of uterine cavity operation ≥4（group c）.The incidence of abnormal uterine cavity under hysteroscopy was compared among the three groups.Results：（1）The incidence of uterine anomalies in group D was significantly higher than that in group A and group B（P〈0.05）.（2）The proportion of the patients whose tubal openings were visible under hysteroscopy in group C or D was significantly lower than that in group A or B（P〈0.05）,while the proportion of tubal openings could not seen under hysteroscopy in groups C or D was significantly higher than that in group A（P〈0.05）.（3）The incidence of menstrual blood volume changed in group D was significantly higher than that in other groups（P〈0.05）.The proportion of menstrual blood volume reduced in groups B,C and D was higher than that in group A（P〈0.05）,and this proportion in group D was higher than in group B（P〈0.05）.The incidence of intrauterine abnormity in the group of menstrual blood volume changed or reduced was significantly higher than that of the group without changed（P〈0.05）.（4）The incidence of uterine anomaly in group a was lower than that in group c（P〈0.05）.Conclusions：The uterine cavity operation especially for induced abortion can cause serious damage to endometrium and affect the tubal function,which can lead to infertility.Therefore,the women of childbearing age should avoid uterine surgery,especially the induced abortion operation.