宫腔镜检查在复发性流产和不孕症患者中的应用

Role of the hysteroscopy in management of the female recurrent spontaneous abortion and infertility

目的评价宫腔镜检查在复发性流产和不孕症诊治中的应用价值和生殖预后。方法回顾性分析2017年1月~12月期间于上海交通大学医学院附属仁济医院住院行宫腔镜检查手术的285例复发性流产或者不孕症患者的临床资料,根据孕产史分为复发性流产组(161例)和不孕症组(124例),比较手术前后两组患者宫腔镜检查结果和生殖预后。结果所有检查均安全完成,无严重并发症发生。共发现子宫畸形12例(4.2%),子宫内膜异常86例(30.2%),输卵管异常79例(27.7%)。术后随访生殖预后,中位随访时间28个月(22~34个月),失访19例,失访率6.7%。另有11例(3.8%)术后因个人原因暂时无生育要求。妊娠率71.8%(183/255),流产率18%(46/255),活产率53.7%(137/255)。与术前相比,整体的自然流产率(85.2%vs.25.1%),活产率(7.4%vs.74.9%),差异均有统计学意义(P<0.05)。复发性流产患者妊娠率无改善,但自然流产率(92.7%vs.32.4%)和活产率(4.8%vs.67.7%)差异均有统计学意义(P<0.05)。不孕症患者妊娠率(57.2%vs.67.3%)、自然流产率(48.6%vs.13.9%)和活产率(19.8%vs.86.1%)差异均有统计学意义(P<0.05)。结论宫腔镜检查对于诊断和治疗宫腔病变以及输卵管通畅程度安全、有效,有助于明确复发性流产和不孕症患者的病因,可以显著改善患者的生殖预后。

Objective To evaluate the value of hysteroscopy in the diagnosis and treatment of recurrent miscarriage and infertility and reproductive prognosis.Methods Retrospective analysis of the clinical data of 285 patients with recurrent miscarriage or infertility who were admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to December 2017.Hysteroscopy results and reproductive prognosis were compared between the recurrent abortion group(161 cases)and the infertility group(124 cases)before and after surgery.Results All hysteroscopic operations were completed safely without serious complications.A total of 12 cases(4.2%)of uterine malformations were found,86 cases of endometrial abnormalities(30.2%),and 79 cases of fallopian tube abnormalities(27.7%).Reproductive prognosis was followed up.The median follow-up time was 28 months(22~34 months),19 patients were lost to follow-up,and the rate of lost follow-up was 6.7%.Another 11 cases(3.8%)temporarily gave up fertility due to personal reasons.The pregnancy rate was 71.8%(183/255),the abortion rate was 18%(46/255),and the live birth rate was 53.7%(137/255).Compared with preoperative data,the overall spontaneous abortion rate(85.2%vs 25.1%)and live birth rate(7.4%vs 74.9%)were statistically significant were statistically significant(P<0.05).The pregnancy rate of patients with recurrent abortion was not improved,but the difference between spontaneous abortion rate(92.7%vs 32.4%)and live birth rate(4.8%vs 67.7%)was statistically significant(P<0.05).The infertility patients had statistically significant differences in pregnancy rate(57.2%vs 67.3%),spontaneous abortion rate(48.6%vs 13.9%),and live birth rate(19.8%vs 86.1%)(P<0.05).Conclusion Hysteroscopy is safe and effective for management of intrauterine lesions and tubal patency.Hysteroscopy would help to identify the etiology of patients with recurrent abortion and infertility,and significantly improve the reproductive prognosis of these patients.