摘要
目的 探讨宫腔镜下宫腔粘连分离术(transcervical resection of adhesions,TCRA)为主导的综合疗法治疗重度宫腔粘连(intrauterine adhesions,IUA)的效果。方法 2015年1月~2018年1月我科对30例重度IUA行TCRA,术后放置宫腔支撑球囊联合医用几丁糖,并辅以人工周期药物治疗3个月,再次宫腔镜检查评估宫腔情况。结果 30例重度IUA术后AFS评分中位数1分(0~10分),明显低于术前中位数10分(10~12分)(Z=-4. 864,P=0. 000)。月经失血图术后中位数评分22. 5分(6~50分),明显高于术前中位数评分7. 5分(0~15分)(Z=-4. 543,P=0. 000)。宫腔复粘率50%(15/30),以轻度粘连为主,仅有4例中度IUA和1例重度IUA。术后月经改善总有效率为90%(27/30)。30例术后随访12~36个月,(18. 4±7. 7)月,自然妊娠8例,其中足月妊娠6例,2例尚妊娠中(9、20孕周);IVF-ET妊娠7例,其中20孕周自然流产1例,22孕周胎儿畸形引产1例;15例未妊娠,其中1例放弃治疗,余14例准备IVF-ET治疗中。结论 TCRA联合医用几丁糖、宫腔支撑球囊并辅以人工周期的综合疗法治疗重度IUA效果明确,能够较有效预防术后再粘连形成,改善月经模式,提高受孕率。
Objective To investigate the effect of combined therapy based on transcervical resection of adhesions(TCRA)on the treatment of severe intrauterine adhesions(IUA).Methods A total of 30 patients with severe IUA undergoing TCRA from January 2015 to January 2018 in our hospital were retrospectively analyzed.The uterine cavity balloon combined with medical chitosan was placed after TRCA.Artificial cycle treatment was administrated for 3 months,followed by secondary hysteroscopy to assess the uterine cavity.Results The median AFS score of the 30 patients after surgery was 1 point(range,0-10 points),which was significantly lower than the preoperative score of 10 points(range,10-12 points)(Z=-4.864,P=0.000).The postoperative median scores of pictorial blood loss assessment chart(PBAC)were 22.5 points(range,6-50 points),which were significantly higher than the preoperative median scores of 7.5 points(range,0-15 points)(Z=-4.543,P=0.000).The intrauterine adhesion rate was 50%(15/30),which was mainly mild adhesion and with only 4 cases of moderate IUA and 1 case of severe IUA.The total effective rate of menstrual improvement was 90%(27/30).All the patients were followed up for 12-36 months,with an average of(18.4±7.7)months.There were 8 cases of natural pregnancy,including 6 cases of full-term pregnancy,2 cases in their first or second trimester(gestational week:9 weeks and 20 weeks,respectively).A total of 7 cases were pregnancy with IVF-ET,including 1 case of spontaneous abortion in 20 weeks,1 case of induced termination of pregnancy at 22 weeks because of fetal anomaly.A total of 15 cases were not pregnant,including 1 case giving up treatment and the remaining 14 cases prepared for IVF-ET treatment.Conclusions Comprehensive therapy based on TCRA has a clearly effect on the treatment of severe IUA,especially combined with uterine balloon,medical chitosan after TCRA,and artificial cycle.It effectively prevents postoperative re-adhesion,improves menstruation and increases pregnancy rate.
作者
李淑红
翟妍
张震宇
王淑珍
Li Shuhong;Zhai Yan;Zhang Zhenyu(Department of Obstetrics and Gynecology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第12期1074-1078,共5页
Chinese Journal of Minimally Invasive Surgery
基金
北京市医管局扬帆计划重点项目(ZYLX201713)
关键词
重度宫腔粘连
宫腔镜
宫腔粘连分离术
Severe intrauterine adhesions
Hysteroscopy
Transcervical resection of adhesions
