不同复查期限对宫腔粘连患者宫腔镜术后复发和妊娠结局的影响

Effect of Different Periods of Review on Recurrence and Pregnancy Outcome After Intrauterine Adhesions

目的 探讨不同复查期限对宫腔粘连患者宫腔镜术后复发和妊娠结局的影响。方法 选取宫腔粘连（IUA）并行宫腔粘连分离术（TCRA）的患者98例。根据其术后宫腔镜复查期限不同分为研究组（49例）和对照组（49例）。研究组于术后第14 d实施首次宫腔镜复查,之后每次月经干净后3~5 d进行宫腔镜复查,持续3个月,对照组仅在术后3个月行宫腔镜复查。术前、术后3个月彩超下查看所有患者子宫内膜厚度、子宫体积以及月经恢复情况,并观察术后3个月宫腔镜下宫腔粘连情况,随访期为3个月~1年。结果 两组患者术前子宫内膜厚度及子宫体积比较,差异无统计学意义（P〉0.05）;研究组患者术后3个月子宫内膜厚度及子宫体积均显著优于对照组（P〈0.05）。术前两组患者月经量和卫生巾用量差异均无统计学意义（P〉0.05）;术后3个月两组患者月经恢复情况与术前比较,差异有统计学意义（P〈0.05）,研究组患者月经恢复情况较对照组更为可观（P〈0.01）。术后3个月复查数据显示,研究组IUA发生率明显低于对照组,组间比较差异有统计学意义（P〈0.05）。结论 对于TCRA术后IUA患者而言,在规范化放置双腔气囊导尿管、节育器以及口服大剂量雌激素的条件下,联合早期规律的宫腔镜复查,能够及时发现是否出现再粘连现象,有效改善患者术后宫内膜厚度、子宫体积以及月经量情况,对缓解患者的病情及提高患者的妊娠率具有重要意义。

Objective To investigate the effect of different periods of review on recurrence and pregnancy outcome after intrauterine ad- hesions. Methods Clinical data were derived from 98 patients with TCRA who were diagnosed as IUA. According to the different period of the postoperative hysteroscopy, the research was divided into the study group （49 cases） and the control group （49 cases）. The research group was reviewed the first time at 14d after the implementation of the first hysteroscopy, and reviewed 3 ~ 5d after each menstrual clean for 3 months; the control group was reviewed once only 3 months after the operation hysteroscopy. The thickness of endometrium, uterine volume and the recovery of menstruation was recorded before and 3 months after operation, and the adhesion of uterine cavity was observed after 3 months. The follow - up period was 3 months - i year. Results Before the operation, the thickness and the volume of the uterine volume was not significantly different（ P 〉 0.05 ）. After three months operation, the thickness of the endometrium and the uterine volume of the study group were significantly better than those in the control group （ P 〈 0.05 ）. There was no significant difference between the two groups before operation （ P 〉 0. 05 ） in the volume of menstrual and the usage of sanitary towel, but the difference was significant （ P 〈 0. 05 ） three months after operation. The menstrual recovery in the study group was significantly higher than that in the control group （ P 〈 0. 01 ）. The data showed that the incidence of IUA in the study group was significantly lower than that in the control group after 3 months operation, and there was significant difference between the two groups （P 〈 0.05）. Conclusion For TCRA IUA patients and in the speci- fication of placement of double lumen balloon guide catheter, device （IUD） and high dose estrogen conditions, combined with early rules of hysteroscopy revealed to discover whether there is the phenomenon of re - adhesion effectively improve the patient of uterine endometrial thickness, uterine volume and menstruation recovery, to alleviate the patient＇s condition and improve the patients with pregnancy rate. It has important significance.