宫腔镜、腹腔镜联合手术对中重度宫腔粘连的效果

Clinical efficacy of hysteroscopy combined with laparoscopy in treating moderate to severe intrauterine adhesions

目的探讨宫腔镜、腹腔镜联合手术在诊断和治疗中重度宫腔粘连的临床效果。方法将120例有生育需求的经宫腔镜检查确诊为中重度宫腔粘连的患者随机分为2组,对照组行宫腔镜下宫腔粘连分离术,观察组行宫腔镜、腹腔镜联合手术。观察2组患者术后宫腔恢复、月经改善情况,并随访2年观察2组患者妊娠情况。结果120例患者均顺利完成手术,观察组术后1、3个月的月经改善率分别为85.0%(51/60)、76.7%(46/60),宫腔再次粘连发生率分别为14.3%(9/60)、21.7%(13/60);对照组术后1、3个月的月经改善率分别为14.3%(9/60)、21.7%(13/60),宫腔再次粘连发生率分别为28.3%(16/60)、40.0%(24/60);随访2年内对照组妊娠率为28.6%(16/56),观察组妊娠率为47.3%(26/55)。结论宫腔镜、腹腔镜联合手术治疗中重度宫腔粘连安全、有效,能够有效恢复宫腔状态,在术后月经恢复、预防粘连复发以及提高术后妊娠率方面均有显著效果。

Objective To evaluate the clinical efficacy of hysteroscopy combined with laparoscopy in moderate to severe intrauterine adhesions.Methods A total of 120 patients diagnosed as moderate to severe intrauterine adhesions by uteroscopy with birth demand in our hospital were randomly divided into two groups.The patients in the observation group performed laparoscopic-hysteroscopic hysteroscopic adhesiolysis,while those in the control group were operated transcervical resection of adhesion(TCRA).The clinical efficacy in improvement of menstruation and prevention of re-adhesion of two groups were observed.The pregnancy outcomes in 2 years of follow-up were observed.Results All the 120 patients successfully completed the surgeries.The improvement rates of menstruation at 1-,3-month were 85.0%(51/60),76.7%(46/60),respectively,in observation group,and 70.0%(42/60),58.3%(34/60),respectively,in control group.The re-adhesion rates at 1-,3-month were 14.3%(9/60),21.7%(13/60)in observation group,and 28.3%(16/60),40.0%(24/60),respectively,in the control group.The pregnancy rate was 47.3%(26/55)in the observation group,and 28.6%(16/56)in the control group at 2-year follow up.Conclusion Laparoscopic combined with hysteroscopy surgery for intrauterine adhesions is safe and practicable,and has preferable efficacy in the recovery of uterine normal function,postoperative menstruation recovery,prevention of re-adhesion and improvement of pregnancy.