人工流产术后宫腔粘连的危险因素分析

Analysis of risk factors and prognosis for intrauterine adhesion after hysteroscopic submucosal myoma

目的探讨人工流产后宫腔粘连的危险因素。方法采取回顾性分析的方法,收集2014年1月至2016年10月皖北煤电集团总医院收治的人工流产后宫腔粘连患者80例作为粘连组,选取同时期人工流产后无粘连患者80例作为非粘连组,比较两组患者的一般资料,通过多因素logistic分析分析影响宫腔粘连的因素;并分析粘连组患者的宫腔镜手术治疗效果。结果粘连组与非粘连组在妊娠次数(t=6.848,P<0.001)、稽留流产次数(t=12.004,P<0.001)、刮宫次数(t=7.24,P<0.001)、无痛人流史(χ^2=5.079,P=0.024)差异有统计学意义。多因素logistic回归分析显示,稽留流产次数(OR:7.083,95%CI:2.406~17.392;P=0.002)、刮宫次数(OR:9.147,95%CI:2.875~32.068;P=0.014)、无痛人流史(OR:5.276,95%CI:1.973~13.492;P=0.029)为宫腔粘连发生的独立危险因素(P<0.05);轻中度宫腔粘连总有效率明显高于重度宫腔粘连(χ^2=16.449,P<0.001)。结论刮宫次数、无痛人流以及稽留流产次数为人工流产后宫腔粘连的危险因素,治疗效果效果与粘连程度有关,宫腔镜下宫腔粘连分离术后给予雌激素、Foley球囊导尿管、节育器和可吸收医用膜的联合治疗有助于减少再粘连发生风险,值得临床重视。

Objective To explore the risk factors of intrauterine adhesions after abortion and the effect of hysteroscopic surgery.Methods Through retrospective analysis method,from January 2014 to October 2016,80 artificial abortion patients with intrauterine adhesions were collected as adhesion group.During the same period,80 patients without adhesion after artificial abortion were selected as non-adhesion group.The general data of the two groups were compared.By logistic multivariate analysis,the influencing factors of intrauterine adhesions were analyzed.And the effect of surgical treatment of hysteroscopic adhesion was analyzed.Results The adhesion group and the non-adhesion group had statistically significant differences in the times of pregnancy(t=6.848,P<0.001),missed abortion(t=12.004,P<0.001),painless curettage times(t=7.24,P<0.001),painless abortion history(χ^2=5.079,P=0.024).Multivariate logistic regression analysis indicated that number of missed abortion(OR:7.083,95%CI:2.406-17.392;P=0.002),curettage times(OR:9.147,95%CI:2.875-32.068;P=0.014),painless abortion of history(OR:5.276,95%CI:1.973-13.492;P=0.029)were the independent risk factors for uterine cavity adhesions(P<0.05).The total effective rate of the mild-to-moderate uterine cavity adhesions was significantly higher than that of the severe uterine cavity adhesions(χ^2=16.449,P<0.001).Conclusion The number of missed abortion,curettage,painless history are independent risk factors for intrauterine adhesion,the effect of treatment is related to the degree of adhesion,hysteroscopic intrauterine adhesions after treated with the combination therapy of estrogen and Foley balloon catheter,IUD and absorbable membrane can help reduce the risk of readhesion,it is worthy of clinical attention.