不同宫腔镜粘连分离术对中重度宫腔粘连患者术后复发和妊娠情况的影响

Effect of different hysteroscopic adhesion separation on postoperative recurrence and pregnancy in patients with moderate and severe intrauterine adhesions

目的探讨不同宫腔镜黏连分离术对中重度宫腔粘连患者术后复发和妊娠情况的影响。方法回顾性分析2020年9月至2022年4月四川锦欣西囡妇女儿童医院收治的180例中重度宫腔粘连患者的临床资料。根据随机数字表法将其分为机械组和能源组,每组90例。能源组采用能源性宫腔镜手术,机械组采用机械性宫腔镜手术。比较两组术后3个月宫腔粘连治疗效果及粘连程度、月经改善情况。比较两组手术时间及术中出血量。比较两组术中并发症发生情况及妊娠结局。结果术后3个月,机械组总有效率高于能源组,美国生育协会(AFS)评分低于能源组,月经改善率高于能源组,手术时间短于能源组,术中出血量多于能源组,术中并发症发生率低于能源组,妊娠成功率高于能源组,差异均具有统计学意义(P<0.05)。结论相较于能源性宫腔镜手术,机械宫腔镜手术具有良好的临床疗效,可有效改善中重度宫腔粘连患者的月经情况,缩短手术时间,虽然术中出血量较多,但安全性更高,可显著改善患者的妊娠成功率。

Objective To explore the effects of different hysteroscopic adhesion separation procedures on postoperative recurrence and pregnancy in patients with moderate to severe intrauterine adhesions.Methods Clinical data of 180 patients with moderate to severe intrauterine adhesions admitted to Sichuan Jinxin Xinan Women and Children′s Hospital from September 2020 to April 2022 were retrospective analyzed.According to the random number table method,they were divided into mechanical group and energy group,with 90 cases in each group.The energy group underwent energy-based hysteroscopy surgery,while the mechanical group underwent mechanical hysteroscopy surgery.The treatment effect,degree of adhesions,and menstrual improvement condition of uterine adhesions were compared between two groups 3 months after surgery.The surgical time and intraoperative blood loss were compared between two groups.The incidence of intraoperative complications and pregnancy outcomes were compared between two groups.Results At 3 months after surgery,the total effective rate of the mechanical group was significantly higher than that of the energy group,the American fertility society(AFS)score was lower than that of the energy group,the menstrual improvement rate was higher than that of the energy group,the surgical time was shorter than that of the energy group,the intraoperative blood loss was more than that of the energy group,the incidence of intraoperative complications was lower than that of the energy group,and the pregnancy success rate was higher than that of the energy group,all of which had statistical significance(P<0.05).Conclusions Compared to energy-based hysteroscopic surgery,mechanical hysteroscopic surgery has good clinical efficacy,which can effectively improve the menstrual condition of patients with moderate to severe intrauterine adhesions,shorten the surgical time,and although there is more intraoperative bleeding,it is safer and can significantly improve the pregnancy success rate of patients.