宫腔镜宫腔残留取胚术的效果及排查宫腔病因的价值分析

Clinical effects of hysteroscopic uterine cavity residual embryo removal surgery and its value in detecting cause of uterine cavity

目的探讨宫腔镜宫腔残留取胚术在流产患者中的临床效果及排查宫腔病因的价值。方法流产不全的住院患者和宫内妊娠时限10~12周需要住院的流产患者100例,随机数字法分为对照组和观察组,每组50例。对照组采用B超监护下无痛清宫术治疗,观察组采用宫腔镜宫腔残留取胚术治疗,2组治疗后1、2、3个月利用彩色多超声对子宫内膜厚度及宫腔粘连情况进行评估,采用免疫组织化学法测定胎盘细胞Eotaxin和RANTES水平,比较2组临床疗效及其排查宫腔病因的价值。结果 2组治疗前子宫内膜厚度比较差异无统计学意义(P>0.05);观察组治疗后1、2、3个月子宫内膜厚度小于对照组(P<0.05);观察组治疗后1、2、3个月宫腔粘连率低于对照组(P<0.05)。观察组治疗后3个月并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者胎盘细胞Eotaxin和RANTES水平阳性表达率,低于对照组(P<0.05)。结论治流产不全的住院患者和宫内妊娠时限10~12周需要住院的流产患者采用宫腔镜宫腔残留取胚术治疗效果理想,能改善子宫内膜厚度,降低宫腔粘连率,值得推广应用。

Objective To investigate the clinical effects of hysteroscopic uterine cavity residual embryo removal surgery and its value in detecting cause of uterine cavity. Methods One hundred women patients with incomplete abortion and those with 10 - 12 w intrauterine pregnancy who had to hospitalized from November 2014 to December 2016 were randomly divided into control group（n = 50） and observation group（n = 50）. The patients in control group were treated by painless curettage under B ultrasound guardianship,however,the patients in observation group were treated by hysteroscopic uterine cavity residual embryo removal surgery. The endometrium thickness and intrauterine adhesions were at 1 m,2 m,3 m after treatment were examined by color Doppler ultrasound. Moreover the expression levels of Eotaxin and RANTES in placental cells were detected by immunohistochemistry. In addition the clinical curative effects were observed and compared between two groups. Results There was no significant difference in endometrium thickness between two groups（P〉 0. 05）. However the endometrium thicknesses in observation group at 1 m,2 m,3 m after treatment were significantly less than those in control group（P〈 0. 05）. Moreover the incidence rates of intrauterine adhesions and complications in observation group at 1 m,2 m,3 m after treatment were significantly lower than those in control group（P〈 0. 05）. In addition the positive expression rates of Eotaxin and RANTES in observation group were significantly lower than those in control group（P〈 0. 05）. Conclusion The hysteroscopic uterine cavity residual embryo removal surgery can obtain satisfactory therapeutic effects in treatment of incomplete abortion and for the patients with 10 - 12 w intrauterine pregnancy,which can improve endometrium thickness,decrease the incidence rate of intrauterine adhesions,therefor,which is worthy of popularization and application in clinical practice.