宫腔镜下创伤性宫腔粘连微创术后粘连复发的因素分析

Analysis of the factors for the recurrence of traumatic intrauterine adhesions after minimally invasive hysteroscopy

目的:探讨创伤性宫腔粘连患者宫腔镜下分离术后粘连复发的危险因素。方法:选取758例行宫腔镜下分离术的创伤性宫腔粘连患者,分析影响术后宫腔粘连复发的相关因素。结果:复发组清宫术次数≥3次、宫腔粘连分离次数≥2次、宫腔镜下电切或激光术、术后未放置物理屏障、术后未使用防粘连药物、有刮宫后闭经史、结缔组织粘连、重度粘连的构成比均明显高于治愈组,复发组术后即刻TGF-β1、PAI-1、TIMP-1以及PDGF-BB水平均高于治愈组;复发组术后雌激素用量低于治愈组。结论:上述指标均是造成宫腔镜下分离术后粘连复发的危险因素,临床工作中需据此积极预防,以减少复发。

Objective:To investigate the risk factors of adhesion recurrence after hysteroscopic dissection in patients with traumatic intrauterine adhesions.Methods:A total of 758 patients with traumatic intrauterine adhesions who underwent hysteroscopic dissection were selected,and the related factors affecting the recurrence of postoperative intrauterine adhesions were analyzed.Results:In the recurrence group,the number of hysterectomy was≥3 times,the number of separation of intrauterine adhesions was≥2 times,hysteroscopic electric resection or laser surgery,no physical barrier was placed after surgery,no anti-adhesion drugs were used after surgery,and there was a history of amenorrhea after curettage The composition ratio of connective tissue adhesion and severe adhesion were significantly higher than those in the cure group.The levels of TGF-β1,PAI-1,TIMP-1 and PDGF-BB in the recurrence group immediately after operation were higher than those in the cure group.The dosage is lower than that of the cured group.Conclusion:The above indicators are all risk factors for the recurrence of adhesions after hysteroscopic dissection,which should be actively prevented in clinical work to reduce recurrence.