影响宫腔镜治疗宫腔粘连疗效相关因素分析

The related factors affecting the efficacy of hysteroscopic transcervical resection of adhesion(TCRA)caused by intrauterine adhesions

目的探讨影响宫腔镜治疗宫腔粘连疗效的相关因素。方法对2012年6月—2013年12月新疆医科大学第一附属医院26例经宫腔镜证实宫腔粘连的患者行宫腔粘连分离术,术后随访观察疗效,并对治疗有效者(有效组)和无效者(无效组)患者进行年龄、症状(月经量减少、闭经、周期不规则、痛经)、术前内膜厚度、病因、人工流产次数、宫腔操作次数、病程时间、宫腔重建满意度、粘连程度、激素治疗后内膜厚度10项因素的差异进行比较,对与疗效可能相关的因素进行统计学分析。结果治疗有效组22例(84.6%),无效组4例(15.3%),单因素分析显示病因、人工流产次数、宫腔操作次数、宫腔重建满意度、激素治疗后子宫内膜厚度5项因素与疗效有关,年龄、症状、术前内膜厚度、粘连程度、病程5项因素与疗效无关。结论减少宫腔操作次数、降低人工流产率、减少宫腔粘连发生率,宫腔镜下宫腔粘连分离术加激素治疗后子宫内膜厚度、宫腔重建满意度是提高疗效相关的主要因素。

Objective To investigate the factors that affect the efficacy of hysteroscopic transcervical resec-tion of adhesion （TCRA）caused by intrauterine adhesions.Methods 2 6 patients diagnosed by hysterosco-py with intrauterine adhesions from the first affiliated hospital of Xinjiang Medical University from June 2012 to December 2013 had underwent raflseervical resection of adhesion.After surgery,all patients were observed the related factors of the efficacy,who were divided into effective and ineffective group according to age,the symptoms,the menstruation endometrial thickness before the operation,etiology,the number of abortion,the number of intrauterine operation,the disease cause of time,the shape of uterine cavity, the degree of intrauterine adhesions,the endometrial thickness after hormone replacement therapy to ana-lyze.Results Out of 26 patients in efficient,there are effective treatment 22 cases （84.6%）,ineffective treatment 4 cases（1 5 .3%）.Single factors showed that the cause of uterine cavity operation,the number of abortion,the shape satisfactions of uterine cavity reconstruction,hormone therapy after endometrial thick-ness of five factors related to the curative effect,while duration of symptoms,the degree of preoperative lining thickness,adhesion,five factors have nothing to do with curative effect.Conclusion Reducing fre-quency of uterine cavity operation,decreasing the rate of induced abortion,reducing caused by intrauterine adhesions,uterine cavity adhesion separation under hysteroscopy surgery and hormone treatment,uterine endometrial thickness after reconstruction of satisfaction are the related factors to improve the curative effect.