宫腔粘连患者生殖预后影响因素分析

Analysis of influencing factors for reproductive outcome of the patients with intrauterine adhesions

目的:探讨宫腔粘连患者生殖预后影响因素。方法:本研究为前瞻性队列研究,选择2017年1月至2018年2月期间就诊于重庆市妇幼保健院的宫腔粘连患者178例,分别统计患者病史(年龄、病程、有无不孕史及复发性流产史、术前宫腔操作次数、术前月经类型、术前增殖晚期子宫内膜厚度)、宫腔形态学指标(包括输卵管开口是否可见、粘连范围、粘连性质)、二探宫腔恢复情况,并与术后妊娠进行单因素及多因素分析。结果:术后妊娠率为59.6%(106/178),活产率为45.5%(81/178),宫腔恢复有效率为88.8%(158/178)。不同病程( P=0.007)、粘连性质( P=0.001)、粘连范围( P=0.001)、二探宫腔恢复情况( P=0.037)的妊娠率差异均具有统计学意义。多因素logistic回归分析结果显示,病程、粘连性质是影响宫腔粘连患者术后妊娠的独立危险因素( P=0.012, P=0.003)。 结论:病程、粘连性质与宫腔粘连患者的生殖结局密切相关。

Objective:To analyze the influencing factors for reproductive outcome of the patients with intrauterine adhesions (IUA).Methods:Totally 178 cases were selected as the subjects in prospective cohort study from those diagnosed with IUA and underwent surgery in Chongqing Health Center for Women and Children from January 2017 to February 2018. The relationships of pregnancy with medical history (including age, course of disease, past history of infertility and recurrent abortion, operation times of uterine cavity, preoperative menstruation, endometrial thickness),morphological index of uterine cavity (including opening of oviduct, adhesion range, adhesion properties) and recovery of uterine cavity were analyzed.Results:The overall pregnancy rate was 59.6% (106/178), the live birth rate was 45.5% (81/178), and the effective rate of uterine cavity recovery was 88.8% (158/178). There were statistical differences in the pregnancy rate of different courses of disease ( P=0.007), adhesion properties ( P=0.001), adhesion range ( P=0.001) and the recovery of uterine cavity ( P=0.037). The logistic statistics showed that course of disease and adhesion properties were independent factors ( P=0.012, P=0.003). Conclusion:The course of disease and adhesion properties were independent factors which influence reproductive outcome of the patients with IUA.