宫腔镜下清宫术处理稽留流产的疗效观察

Clinical Observation of Uterine Curettage under Hysteroscopy for Missed Abortion

目的：探讨宫腔镜指导下清宫术＋宫腔留置透明质酸钠凝胶方案处理稽留流产的方法和效果。方法98例稽留流产患者入院后完善相关检查，给予米非司酮片＋米索前列醇片序贯治疗，而后按照清宫术方法的不同，分为两组。对照组（49例）采用B超监视下清宫术，观察组（49例）采用宫腔镜指导下清宫术＋术后宫腔留置透明质酸钠凝胶。比较两组术后发生二次清宫和宫腔粘连的情况及发现宫腔畸形的几率。结果观察组在术后妊娠物残留和宫腔粘连方面均优于对照组（ P﹤0.05）；在发现细微宫腔畸形方面也具有优势，但与对照组比无统计学差异。结论宫腔镜指导下清宫术＋透明质酸钠凝胶留置宫腔的方法可避免多次清宫，减少宫腔粘连的发生率；并能发现宫腔畸形，及早进行处理。

Objective To explore methods and clinical effects of uterine curettage under hysteroscopy followed by indwelling sodium hyaluronate gel in uterine cavity for missed abortion. Methods 98 patients with missed abortion were given mifepriston and misoprostol sequentially after exclusion of contraindication and other complications. They were assigned to two groups according to different uterine curettage methods. Uterine curettage under B-ultrasound was performed in the control group（49 patients）. Uterine curettage under hysteroscopy followed by indwelling sodium hyaluronate gel in uterine cavity was performed in the observation group（49 patients）. Reoperation,intrauterine adhe-sions and rates of uterine malformation were compared. Results Residual pregnancy tissue and intrauterine adhesions were less in observation group than those in control group（P﹤0. 05）. Moreover,hysteroscopy had advantages in de-tecting slight uterine malformation. However,there was no significant difference between the two groups. Conclusion Uterine curettage under hysteroscopy followed by indwelling sodium hyaluronate gel in uterine cavity can avoid repeat-ed curettage,reduce the incidence of intrauterine adhesions,and can discover slight uterine malformation.