对比分析宫腔镜冷刀技术与宫腔镜电切术治疗宫腔妊娠物残留的疗效及对子宫内膜再生的影响

Comparative analysis of hysteroscopy cold knife technology and residues of hysteroscopic surgery treatment of uterine pregnancy curative effect and influence on endometrial regeneration

目的对比分析宫腔镜冷刀技术与宫腔镜电切术治疗宫腔妊娠物残留的疗效及对子宫内膜再生的影响。方法前瞻性选取宝鸡市中心医院自2021年1月至2022年12月收治的82例宫腔妊娠物残留患者作为研究对象,所有患者均接受宫腔镜手术治疗,依据随机数字表法将其分为对照组和观察组,每组各41例。对照组行宫腔镜电切术治疗,观察组行宫腔镜冷刀技术治疗。比较两组术中情况(手术时间、术中出血量、苏醒时间、经济费用),术后恢复情况[术后住院时间、术后阴道出血时间、术后月经复潮时间、术后人绒毛膜促性腺素(HCG)恢复正常时间],术前及术后3个月、术后6个月的子宫内膜厚度、子宫内膜血流参数[阻力指数(RI)、搏动指数(PI)],一次性治愈率、月经量减少率、术后并发症发生率。结果观察组手术时间为(17.52±5.32)h,短于对照组[(23.09±6.57)h],差异有统计学意义(P<0.05);两组术中出血量、苏醒时间、经济费用比较,差异均无统计学意义(P>0.05)。观察组的术后住院时间、术后阴道出血时间、术后月经复潮时间、术后HCG恢复正常时间分别为(1.09±0.24)、(6.01±1.98)、(29.56±4.87)、(7.68±1.83)d,均短于对照组[(1.21±0.18)、(8.25±2.70)、(33.15±6.82)、(10.01±2.37)d],差异均有统计学意义(P<0.05)。两组术前及术后6个月的子宫内膜厚度、RI、PI比较,差异均无统计学意义(P>0.05);术后3个月,观察组的子宫内膜厚度、RI、PI分别为(8.96±1.57)mm、0.54±0.09、0.80±0.16,均大于对照组[(7.05±1.36)mm、0.42±0.05、0.70±0.13],差异均有统计学意义(P<0.05)。两组一次性治愈率比较,差异无统计学意义(P>0.05);观察组月经量减少率为2.44%,低于对照组(14.63%),差异有统计学意义(P<0.05)。观察组术后并发症发生率为4.88%,低于对照组(24.39%),差异有统计学意义(P<0.05)。结论宫腔镜冷刀技术与宫腔镜电切术治疗宫腔妊娠物残留的疗效相当,前者在促进术后恢复、减少并发症发生和保护子宫内膜上具有显著优势,值得临床予以重视应用。

Objective To analyze the effect of hysteroscopy cold knife technology and hysteroscopic electrotomy on the treatment of residues caused by intrauterine pregnancy and effects on endometrial regeneration.Methods Eighty two patients with residual pregnancy in the uterine cavity admitted to Baoji Central Hospital from January 2021 to December 2022 were prospectively selected as the research subjects,all of whom received hysteroscopic surgery treatment.According to the random number table method,they were divided into the control group and the observation group,with 41 cases in each group.The intraoperative situation(operation time,intraoperative blood loss,awakening time,economic cost),and postoperative recovery[postoperative vaginal bleeding time,postoperative period after tide time,postoperative human chorionic gonadotropin(HCG)returned to normal time],endometrial thickness,endometrial blood flow parameters[postoperative hospital stay,resistance index(RI),pulse index(PI)]before operation,3 months and 6 months after operation,one-time cure rate,menstrual loss rate,postoperative complication rate of two groups were compared.Results The operation time of the observation group was(17.52±5.32)h,which was shorter than that of the control group[(23.09±6.57)h],and the difference was statistically significant(P<0.05).There were no statistically significant differences in intraoperative blood loss,awakening time and economic cost between the two groups(P>0.05).The postoperative hospitalization time,postoperative vaginal bleeding time,postoperative menstrual recovery time,and postoperative HCG recovery time in the observation group were(1.09±0.24),(6.01±1.98),(29.56±4.87),and(7.68±1.83)d,respectively,which were shorter than those in the control group[(1.21±0.18),(8.25±2.70),(33.15±6.82),(10.01±2.37)d],and the differences were statistically significant(P<0.05).There were no statistically significant differences in endometrial thickness,RI and PI between the two groups before operation and 6 months after operation(P>0.05).At 3 months after operation,the endometrial thickness,RI and PI in the observation group were(8.96±1.57)mm,0.54±0.09 and 0.80±0.16,respectively,which were higher than those in the control group[(7.05±1.36)mm,0.42±0.05 and 0.70±0.13],the differences were statistically significant(P<0.05).There was no statistically significant difference in the one-time cure rate between the two groups(P>0.05).The menstrual volume reduction rate of the observation group was 2.44%,which was lower than that of the control group(14.63%),and the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 4.88%,which was lower than that in the control group(24.39%),and the difference was statistically significant(P<0.05).Conclusion Hysteroscopy cold knife technique with hysteroscopic treatment the curative effect of residues caused by intrauterine pregnancy,the former in promoting postoperative recovery,reduce complications and protecting the endometrium has significant advantages,which is worthy of clinical application.