子宫动脉栓塞后宫腔粘连的生殖结局分析

Reproductive outcomes of women treated for intrauterine adhesions following uterine artery embolization

目的探讨既往有子宫动脉栓塞史的宫腔粘连患者行宫腔镜下宫腔粘连分离术后的生殖结局。方法回顾性分析2014年1月至2018年12月在首都医科大学附属复兴医院因宫腔粘连行宫腔镜下宫腔粘连分离术的患者129例,所有患者均有子宫动脉栓塞史。主要观察指标包括术前和术后的宫腔粘连美国生育学会(American Fertility Society,AFS)评分、月经改善情况及生殖结局。结果124例患者获得完整资料及随访。与术前相比,术后2个月宫腔粘连的AFS评分显著降低[10(8,10)分vs 4(4,6)分,P<0.05],50%(62/124)的患者月经量有改善。124例患者术后妊娠29例(23.4%),活产22例(17.7%),足月产13例(44.8%),早产9例(31.0%),自然流产6例(20.7%),妊娠中1例(3.4%)。22例存在活产的患者中,20例(90.9%)发生了产科并发症,包括胎盘异常16例(72.7%),产后出血12例(54.5%)。因产后出血输血5例(22.7%),再次子宫动脉栓塞3例(13.6%),剖宫产同时子宫切除术1例(4.5%)。结论既往有子宫动脉栓塞史的宫腔粘连患者,宫腔镜下宫腔粘连分离术后仅约1/6的患者获得活产,其中大多数会发生严重的产科并发症。

Objective To assess the reproductive outcomes of women treated for intrauterine adhesions(IUA)following uterine artery embolization(UAE).Methods Retrospective study of 129 women with IUA following UAE wishing to conceive,undergoing hysteroscopic adhesiolysis at a tertiary Hysteroscopic Centre of Futting Hospital.The main outcome measures included the American Fertility Society(AFS)IUA score of pre-and post-operation,improvement in menstrual flow and reproductive outcomes.Results Complete follow-up was available for 124 women.Following hysteroscopic adhesiolysis,there was a significant reduction in the AFS score[10(8,10)vs 4(4,6)],(P<0.05),while 62/124(50%)of patients experienced an improvement in menstrual flow.Of 124 women wishing to conceive,29/124(23.4%)achieved a pregnancy and 22/124(17.7%)achieved a live birth.Of the 29 pregnant women,6/29(20.7%)miscarried,9/29(31.0%)had a preterm labour,13/29(44.8%)had a term live birth and 1/29(3.4%)has an ongoing pregnancy.Among those achieving a live birth,90.9%(20/22)suffered significant obstetric complications including abnormal placental implantation 16/22(72.7%),significant post-partum haemorrhage 12/22(54.5%),transfusing 5/22(22.7%),need for further UAE 3/22(13.6%)and caesarean hysterectomy 1/22(4.5%).Conclusion It appears that approximately one-sixth women treated for IUA following UAE will achieve a live birth,of which the majority will suffer significant obstetric complications.