自然流产与子宫腔相关因素分析

Correlation factor analysis on uterine anomalies in patients with abortion

目的探讨不同流产次数与宫腔内先天性异常及获得性异常的关系。方法选择有自然流产史的185例患者，进行宫腔镜诊断，依据宫腔病变形态及形成原因分为先天性及获得性宫腔异常，分别对比1次、2次、≥3次不同流产次数与宫腔先天性及获得性异常的关系。结果宫腔镜检查异常者占79．9％（148／185），其中子宫先天发育异常52．4％（97／185），以子宫不全中隔最常见29．7％（55／185）；获得性子宫异常占21．1％（39／185），以宫腔粘连最常见11．9％（22／185）。发生1次、2次、≥3次自然流产患者宫腔粘连发生率分别占7．4％（5／68）、14．1％（11／78）和15．4％（6／39）。3组宫腔镜检查结果为正常、先天发育异常、获得性异常及先天性合并获得性异常分别为27．9％（19／68）、51．5％（35／68）、17．6％（12／68）和2．9％（2／68），17．9％（14／78）、51．3％（40／78）、24．3％（19／78）和6．4％（5／78），及10．3％（4／39）、56．4％（22／39）、20．5％（8／39）和12．8％（5／39），其结果比较差异无统计学意义（χ2=8．823P=0．184）。结论宫腔镜是探讨流产的子宫腔先天性及获得性异常的简便方法，建议有1次流产史患者尽早行宫腔镜检查及时诊治先天性及获得性宫腔异常。

Objective To explore the relationship between the times of abortion and congenital and acquired uterine anomalies. Methods One hundred and eighty-five patients underwent diagnostic hysteroscopy following abortion were selected and diagnosed by hysteroseopy, then divided into congenital and acquired uterine abnormalities according to the morphology and the formation of uterine cavity lesions. The relationship of 1 times, 2 times, equal or more than 3 times of different number of abortion and uterine congenital and acquired abnormalities were compared respectively. Results Diagnostic hysteroscopy revealed anomalies uterine cavity was 79. 9%（148/185） , of them congenital uterine anomalies was 52. 4% （97/185） , and acquired uterine pathologies was the most of 21.1% （ 39/185 ） , acquired uterine abnormalities was 21.1% （ 39/185 ） , and intrauterine adhesion was the most common of 11.9% （22/185）. Incidence of intrauterine adhesions of natural abortion with 1 times, 2 times and 3 times or more were 7.4% （ 5/68 ） , 14. 1% （ 11/78 ） and 15.4% （ 6/39 ） ~ Hysteroscopy showed that the detection rates of normal uterine cavity, congenital abnormalities, acquired uterine and congenital and acquired pathologies in 3 groups were 27.9% （19/68） , 51.5% （35/68） , 17. 6% （12/68）and 2. 9%（2/68） ;17. 9%（14/78） ,51.3%（40/78） ,24. 3%（19/78） and 6. 4%（5/78） ;10. 3%（4/39） , 56.4% （22/39） ,20. 5% （ 8/39 ） and 12. 8% （ 5/39 ） , respectively, the differences were not significant （ χ2 = 8. 823, P = 0. 184） . Conclusion Hysteroscopy is a simple and efficient tool in the early diagnosis of congenital and acquired uterine anomalies. Diagnostic hysteroscopy can be performed after the first miscarriage in order to early diagnose and treat congenital and acquired uterine pathologies.