中重度宫腔粘连联合诊治的临床效果分析

Clinical efficacy analysis of combined diagnosis and treatment of moderate and severe intrauterine adhesions

目的 探讨中重度宫腔粘连(IUA)患者采用宫腔镜宫腔粘连分离术(TCRA)及术后联合治疗的效果。方法 收集2022年1月—2023年4月天津美津宜和妇儿医院收治的中重度IUA患者32例临床资料,所有患者均实施TCRA恢复宫腔形态,对子宫内膜组织活检进行病理及CD138免疫组化检测,评估合并慢性子宫内膜炎(CE)的情况,术后给予患者雌孕激素治疗,辅以三角球囊子宫支架物理屏障隔离治疗。术后两个月宫腔镜检查评估该联合治疗的效果,患者月经改善情况及妊娠情况。结果 中重度IUA合并CE发病率为40.63%(13/32),口服多西环素200 mg/d,14 d,治愈率为92.31%(12/13)。术后均无感染及并发症发生。二次宫腔镜检查判定治疗有效率为93.75%(30/32)。月经量明显改善和无明显改善比例分别为78.13%(25/32)和21.88%(7/32);术后随访2~15个月,34.38%(11/32)成功妊娠,与末次宫腔镜检查间隔中位时间为5个月。合并CE的中重度IUA治疗后妊娠率为53.85%(7/13)。结论 TCRA是中重度IUA诊断、治疗的标准术式。术后采取雌孕激素序贯治疗为主,辅以宫腔放置生物蛋白胶及宫腔物理屏障的联合治疗可有效预防宫腔再粘连,明显改善月经量,提高术后妊娠率。

Objective To explore the effect of transcervical resection of intrauterine adhesion(TCRA)and postoperative combination therapy on patients with moderate and severe intrauterine adhesions(IUA).Methods The clinical data of 32 patients with moderate and severe IUA admitted to Tianjin Meijin Yihe Women and Children's Hospital from January 2022 to April 2023 were collected.All patients underwent TCRA to restore uterine cavity morphology,endometrial tissue biopsy was performed for pathological and CD138 immunohistochemical testing,to evaluate the condition of concurrent chronic endometritis(CE).After surgery,the patients were given the treatment with estrogen and progesterone,supplemented by physical barrier isolation treatment with triangular balloon uterine stent.Two months after surgery,hysteroscopy was performed to evaluate the effectiveness of this combined treatment,as well as the patient's menstrual improvement and pregnancy status.Results The incidence rate of moderate and severe IUA with CE was 40.63%(13/32),and the cure rate was 92.31%(12/13) after oral administration of doxycycline 200 mg/d for 14 days.There were no the occurences of postoperative infections and complications.The effective rate of treatment determined by secondary hysteroscopy examination was93.75%(30/32).The proportions of significant improvement and no significant improvement in menstrual flow were 78.13%(25/32)and 21.88%(7/32),respectively;after follow-up for 2-15 months,34.38%(11/32)successfully conceived,with a median interval of 5 months between the last hysteroscopy examination.The pregnancy rate after the treatment of moderate and severe IUA combined with CE was 53.85%(7/13).Conclusion TCRA was the standard surgical procedure for the diagnosis and treatment of moderate and severe IUA.Postoperative sequential treatment with estrogen and progesterone,combined with the placement of biological protein glue and physical barrier in the uterine cavity,could effectively prevent uterine re-adhesion,significantly improve menstrual flow and increase postoperative pregnancy rate.