50例结核性宫腔粘连手术效果及妊娠结局分析

Efficiency analysis and reproductive outcome of 50 patients with tuberculous intrauterine adhesion treated by hysteroscopic adhesiolysis

目的:回顾性分析50例结核性宫腔粘连患者经宫腔镜下粘连分离术后宫腔形态、月经恢复情况及生育结局。方法:选取2007年1月至2016年6月就诊于中南大学湘雅三医院妇科的50例结核性宫腔粘连患者,患者均予规范抗结核治疗6~9月后行宫腔粘连分离术,观察患者术后经量、宫腔形态及生育结局。采用Logistic回归对术后经量及宫腔形态恢复情况进行相关影响因素分析。采用四格表Fisher确切概率法分析术后经量及宫腔形态与妊娠的相关性。结果:50例患者中20例恢复正常月经,26例宫腔形态恢复至正常或接近正常。IVF-ET术后6例妊娠,其中2例早期流产,4例成功分娩获得活产儿。Logistic回归分析显示,抗结核治疗后的经量影响患者最终经量的恢复(P<0.05);宫腔粘连程度及抗结核治疗后经量共同影响宫腔形态恢复(P<0.05)。经量恢复正常的患者妊娠率(6/19,31.6%)明显高于经量未恢复正常的患者(0%)(P<0.05);宫腔形态恢复正常的患者妊娠率(6/25,24%)明显高于宫腔形态未恢复正常的患者(0%)(P<0.05)。结论:结核性宫腔粘连患者粘连分离术后经量及宫腔形态恢复欠佳,生育结局差。宫腔粘连分离术能给部分患者带来生育希望,但结核的预防及早期治疗才能减少甚至避免不孕及后续手术治疗。

Objective：To retrospectively assess the efficiency of 50 patients with tuberculous intrauterine adhesion on the uterine cavity,menstrual pattern and reproductive outcome after hysteroscopic adhesiolysis.Methods：Between Jan.2007 and June 2016,50 patients with tuberculous intrauterine adhesion presented in the Third Xiangya Hospital of Central South University were enrolled in the study.All patients were treated by hysteroscopic adhesiolysis after antitubercular drugs for 6 to 9 months.The menstrual volume,uterine cavity and reproductive outcome were recorded during follow-up.Logistic regression and Fisher exact analysis were respectively used to analyze the influencing factors of uterine cavity and menstruation after surgery and the correlation between them and pregnancy.Results：Among 50 patients,20 patients got normal menstruation while 26 patients got a normal or nearly normal uterine cavity.6 patients were pregnant by in vitro fertilization and embryo transfer（IVF-ET）,among which 2 ended up with early abortion,other 4 with live birth.Logistic regression showed menstruation after antitubercular drugs affected the final volume（P〈0.05）.Both the degree of adhesion and menstruation after antitubercular drugs affected the recovery of uterine cavity（P〈0.05）.After hysteroscopic adhesiolysis,the chances of conception in women who got normal menstruation（6 out of 19;31.6%） were significantly higher than those who remained hypomenorrhea even amenorrhea（0%）（P〈0.05）.The conception rate in women who got normal uterine cavity（6 out of 25;24%） were significantly higher than those who had recurrence of intrauterine adhesions（0%）（P〈0.05）.Conclusion：Patients with tuberculous adhesion carry a poor prognosis in menstrual volume and uterine cavity,more importantly in reproductive outcome.Hysteroscopic adhesiolysis could bring a little hope for pregnancy,however the prevention and early treatment are of the most significance to avoid infertility and follow-up surgery.