宫腔镜在不全流产诊治中的价值

Study on diagnostic and therapeutic significance of incomplete abortion by hysteroscopy

目的 评价宫腔镜在不全流产诊治中的应用价值。方法 临床拟诊不全流产的患者 16 8例 ,所有患者均做了经腹B超检查。随后经宫腔镜检确诊为不全流产患者 112例 ,随机分为 2组。研究组接受经宫腔镜妊娠残留物摘除或 /和宫腔镜指导下清宫术 ;对照组接受常规清宫术。比较宫腔镜检与术前B超检查的结果 ,并比较两组手术情况。结果 16 8例中经宫腔镜诊断为不全流产者 112例 ,其中B超诊断为不全流产者89例 ;经宫腔镜检查排除不全流产者 5 6例 ,其中B超提示无不全流产 4 9例 ,两种诊断方法结果差异有显著性 (P <0 .0 5 )。研究组 5 5例完全清除宫内残留妊娠物 ;而对照组中有 19例常规清宫术后复检宫腔镜证实仍有妊娠物残留 ,两组差异有显著性 (P <0 .0 5 )。结论 宫腔镜在不全流产的诊断和治疗中均有很大的价值 ,可首选宫腔镜诊治不全流产。

Objective:To assess the value of hysteroscopy in the diagnosis and treatment of incomplete abortion. Methods:One hundred and sixty-eight out-patients at this hospital,suspected of incomplete abortion clinically,were enrolled in the study. Trans-abdominal B-sonography was used to examine all of them. One hundred and twelve of 168 patients were confirmed incomplete abortion by hysteroscopy subsequently. These 112 patients were divided into two groups randomly. Study group was treated by removal of residual trophoblastic tissue with forceps at hysteroscopy or/and D&C guided by hysteroscopy;controlled group was treated by conventional D&C. The outcomes of trans-abdominal ultrasound and hysteroscopy prior to operation,as well as the operation outcomes of the two groups were compared. Results:One hundred and twelve of 168 patients were confirmed with incomplete abortion by hyteroscopy,while 89 of these 112 patients were indicated incomplete abortion by ultrasound;Among those 56 patienas who were excluded from incomplete abortion by hysteroscopy,49 patients were revealed free of residual tissue by ultrasound. The difference of the outcomes between these two diagnostic methods was significant( P <0.05). Complete removal of the residual tissue was achieved in 55 of 56 patients in study group,while 19 of 56 patients in controlled group were ascertained with retained products of conception after D&C by second-look hysteroscopy. The difference between two groups was significant( P <0.05). Conclusion:Hysteroscopy is invaluable both in confirming the diagnosis and in achieving successful removal of retained product of conception. It is recommended that hysteroscopy be the primary procedure to both diagnosis and treatment of incomplete abortion.