中重度宫腔粘连患者综合治疗的临床疗效分析

Clinical effect analysis of comprehensive treatment for patients with moderate and severe intrauterine adhesions

目的评估宫腔粘连的综合治疗对中重度宫腔粘连不孕患者的临床疗效及妊娠结局的影响。方法回顾性队列研究分析2017年5月1日至2018年5月1日期间在华中科技大学同济医学院附属同济医院生殖医学科住院治疗的148例中重度宫腔粘连的不孕患者为研究对象,根据美国生育协会(American Fertility Association,AFS)评分法将其分为两组:中度组AFS评分5~8分,共79例;重度组AFS评分9~12分,共69例。所有患者均运用宫腔粘连的综合治疗方法,包括宫腔粘连分解术及术后的辅助治疗,如雌激素、物理屏障、生物凝胶等。通过病例调查、电话以及门诊随访,收集其术后复查的宫腔情况、月经及妊娠结局,随访时间为术后24~36个月。结果①术后宫腔的恢复情况:80.41%(119/148)宫腔粘连的患者宫腔环境较前改善,其中79例中度患者中,有65例患者宫腔环境较前明显改善,改善率为82.28%(65/79);69例重度患者有54例宫腔环境明显改善,改善率为78.26%(54/69)。②术后宫腔AFS评分的变化情况:中度宫腔粘连患者术后AFS评分降低(4.10±0.21)分,差异具有统计学意义(P<0.001);重度宫腔粘连患者术后AFS评分降低(7.12±0.30)分,差异具有统计学意义(P<0.001)。③术后月经改善情况:术后前3个月,中度宫腔粘连患者共72例(91.14%)月经较前改善;重度宫腔粘连患者共57例(82.61%)月经较前改善。术后3个月后,中度宫腔粘连患者共52例(65.82%)月经较前改善;重度宫腔粘连患者共41例(59.42%)月经较前改善。④妊娠结局:79例中度宫腔粘连患者中有44例妊娠,37例活产(其中自然妊娠19例,辅助生殖妊娠18例),活产率为84.09%。重度宫腔粘连患者中有33例妊娠,20例活产(其中自然妊娠15例,辅助生殖妊娠5例),活产率为60.61%。结论宫腔粘连的综合治疗可明显改善中重度宫腔粘连患者的宫腔环境,降低AFS评分,改善月经,提高妊娠率,改善妊娠结局。

Objective To evaluate the clinical effect and pregnancy outcome of infertile patients with moderate and severe intrauterine adhesions by comprehensive treatment.Methods Totally 148 infertile patients with moderate to severe intrauterine adhesions who were hospitalized in the Department of Reproductive Medicine of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 1,2017 to May 1,2018 were retrospectively analyzed.They were divided into two groups based on American Fertility Association(AFS)scoring:the moderate group(79 patients)with an AFS score of 5-8 and the severe group(69 patients)with an AFS score of 9-12.All patients received comprehensive treatment for intrauterine adhesions,including intrauterine adhesion decompression and postoperative adjuvant therapy,such as estrogen,physical barrier and biogels.Through case investigation,telephone and outpatient follow-up,the postoperative review of uterine cavity,menstruation and pregnancy outcomes were collected,and the follow-up time was 24-36 months after surgery.Results 1)Postoperative recovery of uterine cavity:80.41%(119 cases of 148)patients with intrauterine adhesions had improved uterine cavity environment,and 65 of 79 moderate patients had significantly improved uterine cavity environment,the improvement rate was 82.28%(65/79).The uterine environment was significantly improved in 54 cases of 69 severe patients,the improvement rate was 78.26%(54/69).2)Changes of postoperative intrauterine AFS score:postoperative AFS score of patients with moderate intrauterine adhesions decreased(4.10±0.21)points,and the difference was statistically significant(P<0.001).AFS score of patients with severe intrauterine adhesions decreased(7.12±0.30)points after operation,and the difference was statistically significant(P<0.001).3)Improvement of menstruation after surgery:in the first 3 months after surgery,72 patients with moderate intrauterine adhesions(91.14%)had improved menstruation.A total of 57 patients(82.61%)with severe intrauterine adhesions had improved menstruation.Three months after surgery,52 patients(65.82%)with moderate intrauterine adhesions had better menses than before;a total of 41 patients(59.42%)with severe intrauterine adhesions had improved menstruation.4)Pregnancy outcome:among 79 patients with moderate intrauterine adhesions,44 cases were pregnant,of which 37 cases delivered live births(19 cases of natural pregnancy,18 cases of assisted reproductive pregnancy),with a live birth rate of 84.09%.There were 33 pregnancies and 20 live births(15 natural pregnancies and 5 assisted pregnancies)in the patients with severe intrauterine adhesions,with a live birth rate of 60.61%.Conclusion The comprehensive treatment of intrauterine adhesions can obviously improve the uterine environment of moderate and severe intrauterine adhesions,reduce AFS score,improve menstruation,increase pregnancy rate and improve pregnancy outcome.