流产术后并发宫腔粘连的危险因素分析及宫腔镜联合雌孕激素的干预效果研究

Analysis of Risk Factors of Intrauterine Adhesions after Abortion and Intervention Effect of Hysteroscopy Combined with Estrogen and Progesterone

目的:分析流产术后并发宫腔粘连的危险因素,并探讨宫腔镜联合雌孕激素对宫腔粘连的干预效果,以期为宫腔粘连的防治提供依据。方法:选取2016年1月至2017年2月于我院接受流产术后并发宫腔粘连的患者100例作为粘连组,另选取同期于我院接受流产术后未发生宫腔粘连的患者100例作为未粘连组。比较粘连组和未粘连组患者基本资料、既往史情况、手术指标,并采用多因素Logistic回归分析流产术后并发宫腔粘连的危险因素。进一步将粘连组按照随机数字表法分成对照组(n=50)和观察组(n=50),对照组患者进行雌孕激素治疗,观察组患者进行宫腔镜联合雌孕激素治疗。比较观察组与对照组患者治疗3个周期后首次月经情况以及临床疗效。结果:粘连组孕次、产次、吸宫时负压、吸宫时间以及合并盆腔炎时间均高于未粘连组,差异均有统计学意义(P<0.05)。经多因素Logistic回归分析可得,吸宫时负压≧500 mm Hg、吸宫时间≧15 min为流产术后并发宫腔粘连的危险因素(P<0.05)。观察组治疗3个周期后首次月经量减少发生率、首次月经中期子宫内膜厚度≤8 mm发生率低于对照组,治疗有效率高于对照组(P<0.05)。结论:吸宫时负压≧500 mm Hg、吸宫时间≧15 min均属于流产术后并发宫腔粘连的独立危险因素,临床应根据以上危险因素采取相应预防措施,以减少宫腔粘连的发生。而对于已发生宫腔粘连的患者,采用宫腔镜联合雌孕激素治疗具有较好的干预效果,值得在临床上推广应用。

Objective: To analyze the risk factors of intrauterine adhesions after abortion, and to explore the intervention effect of hysteroscopy combined with estrogen and progesterone on intrauterine adhesions, to provide a basis for the prevention and treatment of intrauterine adhesions. Methods: 100 patients with intrauterine adhesions after abortion in our hospital from January 2016 to February2017 were selected as adhesion group. Another 100 patients without intrauterine adhesions after abortion in our hospital during the same period were selected as the non-adhesions group. The basic data, past history and surgical indicators between the adhesion group and the non-adhesion group were compared. Multiariable Logistic regression analysis was used to the risk factors of intrauterine adhesions after abortion. The adhesion group was further divided into control group(n=50) and observation group(n=50) according to random number table method. The control group were received estrogen and progesterone treatment, while the observation group were received hysteroscopy combined with estrogen and progesterone treatment. The first menstruation and clinical efficacy of the observation group and the control group after 3 cycles of treatment were compared. Results: Pregnant times, production times, negative pressure during uterine aspiration, time of uterine aspiration and time of pelvic inflammation in adhesion group were higher than those in non-adhesion group, the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed that negative pressure during uterine aspiration ≧500 mm Hg and time of uterine aspiration ≥15 min were risk factors for uterine adhesions after abortion(P<0.05).After 3 cycles of treatment, the incidence of first menstrual volume reduction and the incidence of endometrial thickness ≤8 mm in the middle period of the first menstruation in the observation group were lower than those in the control group, and the effective rate of the treatment was higher than that in the control group(P<0.05). Conclusion: Negative pressure during uterine aspiration ≧500 mm Hg and time of uterine aspiration ≧15 min are all independent risk factors for uterine adhesions after abortion, in order to reduce the occurrence of intrauterine adhesions, corresponding preventive measures should be taken according to the above risk factors. For patients with intrauterine adhesions, hysteroscopy combined with estrogen and progesterone therapy has better intervention effect, which is worthy of clinical application.