宫腔镜宫腔粘连切除后雌激素干预宫腔再粘连危险因素分析

Risk factors of intrauterine re-adhesion with estrogen intervention after hysteroscopic transcervical resection of adhesion

目的:探讨宫腔镜宫腔粘连切除后雌激素干预宫腔再粘连的危险因素。方法:回顾性分析239例宫腔粘连患者的临床资料,所有患者均接受宫腔镜宫腔粘连切除术治疗,且术后予以雌激素干预治疗,根据患者术后1年内宫腔再粘连情况分为再粘连组(n=31)和非再粘连组(n=208)。收集两组患者一般资料,采用单因素及多因素Logistics回归模型分析影响宫腔粘连患者宫腔镜宫腔粘连切除后雌激素干预宫腔再粘连的危险因素。结果:239例接受宫腔镜宫腔粘连切除且予以雌激素干预治疗的患者中,31例发生宫腔再粘连,发生率为12.97%;再粘连组与非再粘连组在病程、人工流产次数、粘连程度、粘连性质、宫腔操作次数、放置宫内节育器及雌激素用量等方面比较,差异有统计学意义(均P<0.05);多因素Logistic回归模型分析结果显示,病程≥1年、人工流产次数>2次、重度粘连、肌性粘连、宫腔操作次数>2次、未放置宫内节育器、小剂量雌激素均为宫腔粘连患者宫腔镜宫腔粘连切除后雌激素干预宫腔再粘连的独立危险因素(均P<0.05);雌激素大剂量组不良反应发生率为18.26%高于雌激素小剂量组的8.87%(P<0.05)。结论:病程≥1年、人工流产次数>2次、重度粘连、肌性粘连、宫腔操作次数>2次、未放置宫内节育器、小剂量雌激素是宫腔镜宫腔粘连切除后雌激素干预宫腔再粘连的危险因素,临床需重视上述危险因素并据此予以针对性措施,以期降低宫腔再粘连风险。

Objective:To explore the risk factors of intrauterine re-adhesion with estrogen intervention after hysteroscopic transcervical resection of adhesion(TCRA).Methods:A retrospective analysis was performed on the clinical data of 239 patients with intrauterine adhesion.All underwent hysteroscopic TCRA and then were given estrogen intervention.According to presence or absence of intrauterine re-adhesion within 1 year after surgery,they were divided into re-adhesion group(31 cases)and non-re-adhesion group(208 cases).General data in both groups were collected.Risk factors of intrauterine re-adhesion were analyzed by univariate analysis and multivariate Logistic regression analysis.Results:Among the 239 patients,there were 31 cases(12.97%)with intrauterine re-adhesion.The differences in disease course,times of induced abortion,adhesion degree,natures of adhesion,times of intrauterine operations,placement of intrauterine device and dosage of estrogen between two groups were statistically significant(all P<0.05).The results of multivariate Logistic regression analysis showed that disease course≥1 year,times of induced abortion>twice,severe adhesion,muscular adhesion,times of intrauterine operations>twice,no placement of intrauterine device and low-dose estrogen were independent risk factors of intrauterine re-adhesion(all P<0.05).The incidence of adverse reactions in high-dose estrogen group was higher than that in low-dose estrogen group(18.26%vs.8.87%,P<0.05).Conclusion:Disease course≥1 year,times of induced abortion>twice,severe adhesion,muscular adhesion,times of intrauterine operations>twice,no placement of intrauterine device and low-dose estrogen are risk factors of intrauterine re-adhesion with estrogen intervention after hysteroscopic TCRA.Clinically,it is necessary to pay attentions to the above risk factors and take targeted measures accordingly in order to reduce the risk of intrauterine re-adhesion.