宫腔镜下宫腔粘连分离术后粘连复发因素分析及预防对策

Analysis of the factors of the recurrence of intrauterine adhesion of patients after transcervical resection of adhesions and the preventive countermeasures for the recurrence of adhesion

目的:探讨宫腔镜宫腔粘连分离术(TCRA)后粘连复发高危因素,为制定针对性预防对策提供参考。方法:回顾性收集2019年10月-2021年10月于本院接受TCRA的宫腔粘连患者126例临床资料,观察术后粘连复发情况。通过单因素分析、多因素logistic回归分析TCRA后粘连复发危险因素;受试者工作特征(ROC)曲线分析各独立危险因素对TCRA后粘连复发预测价值。结果:126例患者术后1年复发率14.3%。单因素分析,病程、人工流产次数、宫腔操作次数、清宫术后闭经史、宫腔粘连性质、范围、术后是否放置物理屏障、雌激素用量均与TCRA后粘连复发有关;多因素logistic回归分析,人工流产次数多、宫腔操作次数多、清宫术后闭经史,宫腔粘连性质肌性、范围大,术后未放置物理屏障、雌激素用量小均为TCRA后粘连复发独立危险因素(均P<0.05)。ROC曲线分析,上述各独立危险因素(人工流产次数、宫腔操作次数、清宫术后闭经史、宫腔粘连性质、范围、术后是否放置物理屏障、雌激素用量)均对TCRA后粘连复发有一定预测价值,曲线下面积分别为0.679、0.648、0.616、0.676、0.742、0.648、0.644。结论:TCRA后粘连复发高危因素包括人工流产次数多、宫腔操作次数多,清宫术后闭经史,宫腔粘连性质肌性、范围大,术后未放置物理屏障、雌激素用量小,可为预测术后粘连复发提供参考依据,利于临床干预预防。

Objective:To investigate the high-risk factors of the recurrence of intrauterine adhesion of patients after transcervical resection of adhesions(TCRA),and to study the preventive countermeasures for the recurrence of TCRA.Methods:The clinical data of 126 patients with intrauterine adhesions who had undergone TCRA from October 2019 to October 2021 were retrospectively collected to observe the postoperative adhesions recurrence.The exploration of risk factors for recurrence of adhesions after TCRA was conducted by univariate analysis and multifactorial logistic regression analysis.The predictive value of these independent risk factors for the adhesion recurrence after TCRA was observed by receiver operating characteristic(ROC)curve.Results:The adhesion recurrence rate of 126 patients within one year after TCRA was 14.3%.Univariate analysis showed that the duration of disease,the number of induced abortion,the number of uterine operations,the history of amenorrhea after uterine curettage,the muscular nature and the scope of uterine adhesions,the physical barrier inserted in uterine cavity after surgery or not,and the dosage of estrogen of the patients were all related to their recurrence of adhesions after TCRA.Multivariate logistic regression analysis showed that the independent risk factors for adhesion recurrence of the patient after TCRA included the high frequency of induced abortion and intrauterine operations,the history of amenorrhea after uterine curettage,the muscular nature and large scope of intrauterine adhesion,no physical barrier inserted in uterine cavity after surgery,and the less dosage of estrogen used(all P<0.05).ROC curve analysis showed that the number of induced abortion,the number of uterine operations,the history of amenorrhea after uterine curettage,the nature and scope of uterine adhesions,the physical barrier inserted in uterine cavity after surgery or not,and the dosage of estrogen used of the patients had all certain predictive values for their adhesion recurrence after TCRA,and the areas under the curve of which were 0.679,0.648,0.616,0.676,0.742,0.648,and 0.644,respectively.Conclusion:The high risk factors of the recurrence of adhesions after TCRA of the patients include the high frequency of induced abortion and intrauterine operations,the history of amenorrhea after uterine curettage,the muscular nature and large scope of intrauterine adhesion,no physical barrier inserted in uterine cavity after surgery,and the less dosage of estrogen used,which can provide evidences for predicting the recurrence of postoperative adhesions and can facilitate the appropriate intervention and prevention in clinic.