宫腔镜在诊治宫内妊娠组织残留的时机选择及安全性

Timing and safety of hysteroscopy in the diagnosis and treatment of residual pregnancy tissue in the uterus

目的探索不同时机宫腔镜诊治人工流产后宫内妊娠组织残留的效果及安全性。方法回顾性收集深圳市龙岗区妇幼保健院2020年8月至2021年1月收治的90例人工流产后宫内妊娠组织残留患者的临床资料,均接受宫腔镜下残留妊娠组织物清除术治疗,根据患者人工流产后入院复查时间及自愿选择的手术时机不同分为三组,A组(n=31)手术时机为人工流产术后2周内,B组(n=38)手术时机为人工流产术后3~4周,C组(n=21)手术时机为人工流产术后5~8周。比较三组患者手术治疗效果,术后并发症发生率(包括出血、感染、穿孔、宫颈裂伤、宫腔粘连),术后恢复效果[包括术后阴道流血时间、月经恢复时间、血清人绒毛膜促性腺激素(HCG)下降至正常需要时间、子宫内膜厚度]和患者满意度。结果A组出血量明显高于B组及C组(P<0.05),B组、C组出血量比较,差异无统计学意义(P>0.05);三组手术时间、一次性完整切除率比较,差异无统计学意义(P>0.05);A组、B组、C组术后并发症发生率比较,差异无统计学意义(P>0.05),但术后阴道流血时间、月经恢复时间和血清HCG下降至正常需要时间依次延长,患者满意度依次降低,差异有统计学意义(P<0.05)。结论对于人工流产后宫内妊娠组织残留患者而言,不同手术时机宫腔镜下清宫术对手术效果及安全性影响不显著,2周内手术会增加手术出血量,但术后恢复情况及患者满意度更佳,建议根据患者实际情况确定手术时机。

Objective To explore the effect and safety of hysteroscopy at different times in the diagnosis and treatment of residual pregnancy tissue in the uterus after induced abortion.Methods The clinical data of 90 patients with residual pregnancy tissue in the uterus after induced abortion in Longgang Maternal and Child Healthcare Hospital of Shenzhen City from August 2020 to January 2021 were collected retrospectively.All patients were treated with hysteroscopic removal of residual pregnancy tissue.They were divided into three groups according to the time of hospitalization and the time of operation:patients in group A(n=31)were operated within 2 weeks after induced abortion,patients in group B(n=38)were operated 3-4 weeks after induced abortion and patients in group C(n=21)were operated 5-8 weeks after induced abortion.The efficacy of surgical treatment,the incidence of postoperative complications(including bleeding,infection,perforation,cervical laceration and intrauterine adhesion),the postoperative recovery effect(including vaginal bleeding time,menstrual recovery time,the time required for serum human chorionic gonadotropin[HCG]to drop to normal,and endometrial thickness)and patient satisfaction were compared among the three groups.Results The amount of bleeding in group A was significantly higher than that in group B and C(P<0.05),but there was no statistically significant difference in the amount of bleeding between group B and C(P>0.05).There were no statistically significant differences in operation time and one-time complete resection rate among the three groups(P>0.05).There was no significant difference in the incidence of postoperative complications among group A,group B and group C(P>0.05),but the vaginal bleeding time,menstrual recovery time and the time required for serum HCG to drop to normal after operation were prolonged in turn,and the patient satisfaction was decreased in turn during follow-up,with statistically significant difference(P<0.05).Conclusion For patients with residual pregnancy tissue in the uterus after induced abortion,hysteroscopic uterine curettage at different operation times has no significant influence on the operation effect and safety.Operation within 2 weeks can increase the amount of bleeding,but the postoperative recovery and patient satisfaction are better.Therefore,it is suggested to determine the operation timing ac cording to the actual condition of patients.