子宫动脉栓塞术后中重度宫腔粘连疗效分析

Analysis of clinical efficacy of moderate and severe intrauterine adhesions following uterine arterial embolization

目的评价子宫动脉栓塞术后中重度宫腔粘连患者治疗的临床效果。方法本研究为临床疗效分析。120例中重度宫腔粘连患者入组，均采用美国生育学会（AFS）宫腔粘连评分分级标准进行宫腔镜下诊断分级。其中有子宫动脉栓塞（UAE）史60例为观察组，无子宫动脉栓塞术史60例为对照组，两组患者均采用宫腔镜下宫腔粘连分解术，术后3个月行第2次宫腔镜探查术，再次对宫腔粘连程度进行分级。主要评价指标：术后3个月时治疗宫腔粘连的有效率。次要评价指标：对宫腔粘连累及范围、粘连类型、月经模式的得分进行手术前后和组问比较。结果观察组治疗宫腔粘连的有效率37．04％（20／54），明显低于对照组的有效率82．46％（47／57），两组比较差异有统计学意义（P〈0．05）。观察组术后AFS总分[（6．06±3．18）分]明显高于对照组[（3．88±3．01）分]，差异有统计学意义（P〈0．05）；观察组宫腔粘连累及范围[观察组（1．78±1．37）分，对照组（1．12±0．93）分]；粘连类型[观察组（2．50±1．51）分，对照组（1．89±1．51）分]；月经模式[观察组（1．78±0．74）分，对照组（0．86±0．99）分]各项得分改善均不如对照组（P=0．004，0．037，0．001）。观察组术后3个月时中重度宫腔粘连的发生率为66．7％，而对照组为40．3％，两组比较差异有统计学意义（P〈0．05）。结论子宫动脉栓塞术后中重度宫腔粘连的患者宫腔粘连分解术后宫腔再粘连率高于非子宫动脉栓塞术后患者，有效率更低，对宫腔粘连分解术后再次受孕等影响更大，应引起临床医生的重视，严格把握子宫动脉栓塞术的指征。

Objective To evaluate the efficacy of moderate and severe intrauterine adhesion （IUA） following uterine arterial embolization （UAE） after hysteroscopic adhesiolysis. Methods A analy- sis of clinical efficacyl was performed. According to American Fertility Society （AFS） scoring system, 60 cases following UAE were used for the observation group, 60 cases without following UAE were used for the control group. Hysteroscopic adhesiolysis was performed in two groups. Second-look hysteroscopic examina- tion was performed to all patients at 3 months postoperatively for evaluation of IUA. Primary endpoint was the reduction rate of IUA at 3months afer hysteroscopic adhesiolysis. The secondary endpoint includes total AFS score, and score of each individual AFS category. Results At 3 months after surgery, the observasion group resulted in significantly lower effective rate for reduction of adhesion, the effctive rate were 37.04% （20/54） and 82.46% （47/57） （ P 〈 0. 05 ） ; the tatal AFS score of the observation group （ 6. 06 ± 3.18 ）, and significantly lower than that of the control group （3.88 ＋ 3.01, P 〈 0. 05 ） , meanwhile, with regard to their adhension area, adhension type, menstrual pattern, the score of the observation group （ 1.78 ± 1.37, 2. 50 ± 1.51, l. 78 ± 0. 74） , and significantly lower than that of the control group （ 1. 12 ± 0. 93,1.89 ± 1.51,0. 86 ± 0. 99 ） （P = 0. 004,0. 037,0. 01 ）. The observation group had singnificantly lower proportion than that of the control group （ P 〈 0. 05 ）. Conclusions The women with moderate and severe intrauterine adhesion following UAE had singnificantly the lower effective rate for reduction of adhesion, the higher rate of re adhesion and the poorer outcome of regerenation after hysteroscopic adhesiolysis. Gynecologist strictly grasps indications of uterine arterial embolization.