中重度宫腔粘连的高危因素分析

Analysis of High Risk Factors for Moderate to Severe Intrauterine Adhesions

目的:探讨引起中重度宫腔粘连(IUA)的高危因素,为临床上预防IUA提供参考。方法:选择2019年1月至2020年2月重庆市妇幼保健院收治的157例IUA患者为研究对象,按照IUA的严重程度分为轻度IUA组(53例)和中重度IUA组104例,比较两组患者的病史情况、宫腔操作类型及宫腔感染(子宫内膜结核)等指标,探讨中重度IUA发生的高危因素。结果:①中重度IUA组与轻度IUA组患者的年龄、不孕史、复发性流产(RSA)史、非妊娠宫腔操作史、早期人工流产次数及子宫内膜结核史组间差异无统计学意义(P>0.05);而病程、宫腔操作次数、稽留流产清宫史、妊娠中晚期产后清宫史组间差异有统计学意义(P<0.05)。其中,病程>1年的患者发生中重度IUA的概率显著高于病程≤1年患者,差异有统计学意义(P<0.05);宫腔操作次数≥3次的患者发生中重度IUA的概率显著高于2次及≤1次患者,差异有统计学意义(P<0.05);有稽留流产清宫史及妊娠中晚期产后清宫史的患者均较无稽留流产清宫史及妊娠中晚期产后清宫史的患者发生中重度IUA的概率高,差异有统计学意义(P<0.05)。②多因素Logistic回归分析得出:宫腔操作次数≥3次(OR 3.079,95%CI 1.177~8.148,P<0.05)与有妊娠中晚期产后清宫史(OR 5.147,95%CI 1.355~19.558,P<0.05)是中重度IUA发生的独立危险因素。结论:宫腔操作次数≥3次和妊娠中晚期产后清宫可能是导致中重度IUA发生的独立危险因素,避免或减少不必要的宫腔操作对预防IUA具有重要意义。

Objective:To explore the high risk factors of moderate-severe intrauterine adhesions(IUA),aiming to provide reference for clinical prevention of IUA.Methods:157 patients with IUA admitted to Chongqing Health Center for Women and Children from January 2019 to February 2020 were selected,according to the degree of IUA,they were divided into mild IUA group(53 cases)and moderate-severe IUA group(104 cases).The medical history,the type of intrauterine operations and intrauterine infection(endometrial tuberculosis)were compared between the two groups,and the high-risk factors for moderate-severe IUA were analyzed.Results:①There were no significant differences in age,infertility history,RSA history,non-pregnant-related intrauterine surgery history,number of early induced abortions and endometrial tuberculosis history between moderate-severe IUA group and mild IUA group(P>0.05);while the course of IUA,the number of intrauterine operations,missed abortion curettage history and the history of postpartum curettage in the middle and late pregnancy were significantly different between the two groups(P<0.05).Among them,the probability of moderate-severe IUA in patients with a course of disease>1 year was significantly higher than that in patients with a course of disease≤1 year(P<0.05);the probability of moderate-severe IUA in patients with≥3 times of intrauterine operations was significantly higher than that in patients with 2 or≤1 times of intrauterine operations(P<0.05);patients with missed abortion curettage history and the history of postpartum curettage in themiddle and late pregnancy had a higher probability of moderate-severe IUA than those without them(P<0.05).②Multivariate Logistic regression analysis showed that the number of intrauterine operations≥3 times(OR 3.079,95%CI 1.177-8.148,P<0.05)and the history of postpartum curettage in the middle and late pregnancy(OR 5.147,95%CI 1.355-19.558,P<0.05)were independent risk factors of moderate-severe IUA.Conclusions:The number of intrauterine operations≥3 times and postpartum curettage in the middle and late pregnancymay be the independent risk factors for moderate-severe IUA,avoiding and reducing unnecessary intrauterine manipulation is of great significance for preventing IUA.