探讨不同宫腔粘连分类标准对其术后生殖结局的预测价值

Predictive Value of Different Intrauterine Adhesions Classification Systems on Postoperative Reproductive Outcome

【目的】探讨宫腔粘连(IUA)不同分类标准在预测其术后生殖结局方面的意义。【方法】搜集2017年1月至2018年2月在重庆市妇幼保健院诊断IUA并且进行宫腔镜手术的患者,最后纳入178名作为研究对象。所有入选患者均行宫腔粘连分离术,分别采用美国AFS评分、欧洲ESGE评级、Nasr评分以及国内评分系统进行完整评分,分析比较不同评分系统对IUA患者术后妊娠率和活产率的预测价值。【结果】①术前不同月经类型、术后不同月经恢复情况及输卵管开口是否可见的妊娠率及活产率组间差异无统计学意义(P>0.05)。不同粘连范围及粘连性质的妊娠率及活产率组间差异有统计学意义(P<0.05)。②在4种评分标准下,不同粘连程度间的妊娠率差异有统计学意义(P<0.05);AFS评分、ESEG评级、Nasr评分下不同粘连程度间的活产率差异有统计学意义(P<0.05),而国内评分下不同粘连程度间的活产率异无统计学意义(P>0.05)。③各评分系统对妊娠结局的预测效能:AFS评分、ESEG评级、Nasr评分内国内评分妊娠率曲线下面积(AUC)依次为0.609、0.602、0.645和0.588;活产率AUC依次为0.596、0.617、0.638和0.575。国内评分下妊娠率、活产率的AUC最小,Nasr评分下妊娠率、活产率的AUC最大,但均<0.7。【结论】粘连范围越大、性质越偏肌性、程度越重,其生殖结局越差;AFS评分、ESGE评级、Nasr评分以及国内评分系统在预测生殖结局方面均存在一定缺陷。临床上需进一步探讨及制定更合理的评分标准来预测生殖结局。

【Objective】To explore the effects of different intrauterine adhesion(IUA)classification systems on predicting the IUA reproductive outcome.【Methods】Totally 178 cases who were diagnosed with IUA and underwent surgery in Chongqing Health Center for Women and Children from Jan.2017 to Mar.2018 were selected as subjects in the present study.All enrolled patients underwent hysteroscopic separation of IUA.According to the actual situation,all patients were scored by AFS,ESGE,Nasr and Chinese classification for comparing the effects of different IUA classification systems on predicting the pregnancy rate and live birth rate after surgery.【Results】①There was no significant difference in pregnancy rate and live birth rate between different preoperative menstrual pattern,different menstrual recovery and the fallopian tube opening(P>0.05).There were statistically significant differences in pregnancy rate and live birth rate among different adhesion ranges and adhesion properties(P<0.05).②There was statistical significance in pregnancy rate among different adhesion degrees under four scoring criteria(P<0.05).There was statistically significant difference in the live birth rate among different adhesion degrees under AFS score,ESEG rating and Nasr score(P<0.05),while there was no statistically significant difference in the live birth rate among different adhesion degrees under Chinese score(P>0.05).③The predictive efficacy of the four scoring systems on pregnancy outcome:The AUC(AFS score,ESEG score,Nasr score and Chinese score)of pregnancy rate was 0.609,0.602,0.645 and 0.588 respectively.The AUC of the live birth rate was 0.596,0.617,0.638 and 0.575,respectively.The AUC of the Chinese score was the smallest,while the AUC of pregnancy rate and live birth rate under NASR score were the largest,but both were<0.7.【Conclusions】The larger range of adhesion,the muscle nature and the more severe degree of adhesion,the worse of reproductive outcome.The AFS,ESGE,NASR and Chinese scoring systems are all deficient in predicting reproductive outcomes.Clinically,it is necessary to further explore and develop more reasonable scoring criteria to predict reproductive outcomes.