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中重度宫腔粘连冷刀分离术后生殖预后的影响因素分析

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摘要 目的探讨中重度宫腔粘连患者行宫腔镜冷刀分离术后生殖预后的影响因素。方法选择2017年5月至2019年5月中重度宫腔粘连(IUA)患者215例,采用宫腔镜冷刀分离术为主的综合治疗,分析手术前后相关临床指标,随访术后3年内的生殖结局。结果215例中重度IUA患者总妊娠率66.98%,活产率50.23%,其中206例为自然受孕,妊娠139例,治疗后IUA分级好转率89.8%。单因素分析显示不同年龄、病程、流产次数、术前子宫内膜厚度、复查子宫内膜厚度患者的妊娠率差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄<35岁、病程>12个月、术前子宫内膜厚度≥6 mm和IUA分级改善是影响中重度IUA患者术后妊娠的独立因素(P<0.05)。结论年龄、病程、术前子宫内膜厚度及IUA分级改善情况是影响中重度宫腔粘连患者生殖结局的重要因素。 Objective To investigate factors affecting reproductive prognosis in patients with moderate to severe uterine adhesions after Hysteroscopic Cold Knife Separation.Methods A total of 215 patients with moderate to severe intrauterine adhesions,who were diagnosed in Wenzhou People's Hospital between May 2017 and May 2019,were selected and underwent comprehensive treatment based on hysteroscopic cold knife separation surgery.The relevant clinical indicators before and after the operation were counted,and the reproductive outcomes within 3 years after the operation were followed up.Results The overall pregnancy rate in 215 patients with moderate-to-severe IUA was 66.98%,with a live birth rate of 50.23%.Of these,206 pregnancies were naturally conceived,resulting in 139 pregnancies.The rate of improvement in IUA grading after treatment was 89.8%.Univariate analysis revealed statistically significant differences in pregnancy rates among various factors,including age,disease duration,number of miscarriages,pre-treatment endometrial thickness,and post-treatment endometrial thickness(P<0.05).Multivariate logistic regression analysis showed that age,course of disease,endometrial thickness before treatment,and improvement of IUA grade were independent factors affecting pregnancy in patients with moderate to severe IUA(P<0.05).Conclusion Age,course of disease,endometrial thickness before treatment,and improvement of IUA grade are important factors affecting the reproductive outcome of patients with moderate to severe intrauterine adhesions.
出处 《浙江临床医学》 2024年第6期909-912,共4页 Zhejiang Clinical Medical Journal
基金 温州市科技计划项目(Y2020487)。
关键词 生殖预后 宫腔粘连 妊娠 宫腔镜冷刀分离 Reproductive prognosis Intrauterine adhesions Pregnancy Hysteroscopic cold knife separation
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