MA患者清宫术后宫腔粘连的发生率及相关因素分析

Intrauterine adhesion after uterine curettage of missed abortion: Analysis of incidence and related factors

目的探讨稽留流产(MA)患者清宫术后宫腔粘连的发生率及影响因素。方法选取我院2018年3月~2019年3月行清宫术后的MA患者210例,随访半年,根据其是否发生宫腔粘连分为粘连组和对照组。比较两组患者的一般资料、血清雌激素和炎症因子水平及阴道三维超声检测结果;应用Logistic回归分析MA患者清宫术后发生宫腔粘连的影响因素。结果在半年的随访过程中,共44例患者发生宫腔粘连,发生率为20.95%。两组患者在既往流产次数、手术时间、超敏C反应蛋白(hs-CRP)、雌二醇(E2)、子宫内膜厚度(ED)、内膜体积(EV)上存在明显差异(P<0.05)。回归结果显示,hs-CRP(HR=1.315,P=0.033),既往流产次数(HR=3.005,P=0.000)是MA患者清宫术后发生宫腔粘连的独立危险因素(P<0.05);血E2(HR=0.950,P=0.000)、ED(HR=0.000,P=0.000)、EV(HR=0.068,P=0.000)是MA患者清宫术后宫腔粘连的独立保护性因素(P<0.05)。结论 MA患者清宫术后宫腔粘连的发生率较高,其中既往流产次数、术后高水平的hs-CRP是其独立危险因素,术后血E2水平、ED、EV是其独立保护性因素。

Objective To explore the incidence and influencing factors of intrauterine adhesions in patients with missed abortion(MA) after uterine curettage. Methods 210 MA patients who underwent uterine curettage from March 2018 to March 2019 in our hospital were selected and followed up for half a year. They were divided into the adhesion group and the control group according to whether they had intrauterine adhesions. General data, serum estrogen and inflammatory factor levels, and three-dimensional vaginal ultrasound results were compared between the two groups. Logistic regression was used to analyze the influencing factors of intrauterine adhesions in patients with MA after uterine curettage. Results During the half-year follow-up, a total of 44 patients developed intrauterine adhesions, with an incidence rate of 20.95%. There were significant differences in the number of previous abortions, operation time, high-sensitivity C-reactive protein(hs-CRP), estradiol(E2), endometrial thickness(ED), and endometrial volume(EV) between the two groups(P<0.05). Regression results showed that hs-CRP(HR=1.315, P=0.033) and the number of previous abortions(HR=3.005, P=0.000) were independent risk factors for intrauterine adhesions in MA patients after uterine curettage(P<0.05);blood E2(HR=0.950, P=0.000), ED(HR=0.000, P=0.000) and EV(HR=0.068, P=0.000) were independent protective factors for intrauterine adhesions after uterine curettage(P<0.05). Conclusion The incidence of intrauterine adhesions is higher in patients with MA after uterine curettage. The number of previous abortions and high postoperative hs-CRP are independent risk factors. Postoperative blood E2 levels, ED, and EV are independent protective factors.