摘要
目的分析宫腔粘连(IUA)患者中慢性子宫内膜炎(CE)的患病率、治愈率以及宫腔镜下宫腔粘连分离术(TCRA)后的再粘连率,探讨CE对IUA治疗结局的影响。方法回顾性分析2019年12月至2021年12月在武汉大学人民医院生殖医学中心行宫腔镜手术患者的临床资料。宫腔镜下诊断为IUA并行TCRA者为IUA组(394例),并根据美国生育协会(AFS)标准于术中将IUA分为轻度、中度和重度;宫腔镜下显示为正常宫腔形态者为对照组(363例)。两组患者均于术中活检子宫内膜,行组织学和CD138免疫组织化学检测评估CE情况。分析CE患病率及CE分级与IUA形成的关系。并根据IUA术后宫腔恢复情况将患者分为正常宫腔组(303例)和再粘连组(91例),分析CE患者1疗程抗生素后未转阴率在两组间的差异,并用多因素Logistic回归分析CE未治愈对IUA治疗结局的影响。结果IUA组CE的发病率为41.12%(162/394),1疗程抗生素后CE治愈率为83.59%(136/162)。与对照组比较,IUA组的年龄更大,妊娠次数、流产次数更多,既往生化妊娠史、人工流产史、自然流产史、胎盘组织残留史、子宫纵隔手术史等病史及CE患病率更高(P<0.05)。将上述因素纳入二元Logistic回归分析,结果显示,确诊CE、既往妊娠次数、人工流产史、自然流产史、子宫纵隔手术史是影响IUA形成的独立危险因素(P<0.05),而生化妊娠史是IUA形成的保护因素(P<0.05)。与TCRA术后正常宫腔组相比,再粘连组的前次IUA分度更重、1疗程抗生素后CE未转阴率更高(P<0.05);二元Logistic回归分析分析显示,1疗程抗生素后CE仍未转阴是IUA治疗结局的独立危险因素(P<0.05)。结论IUA患者中CE患病率明显增高,而CE的治愈率直接影响IUA患者治疗结局。
Objective:To analyze the prevalence and cure rate of chronic endometritis(CE)in patients with intrauterine adhesion(IUA)and the re-adhesion rate after hysteroscopic intrauterine adhesion separation(TCRA),and to investigate the influence of chronic endometritis on the treatment outcome of IUA.Methods:The clinical data of patients who underwent hysteroscopic surgery in Center of Reproductive Medicine of Renmin Hospital of Wuhan University from December 2019 to December 2021 were retrospectively analyzed.The patients diagnosed with IUA who underwent TCRA were included in the IUA group(n=394).According to the American Fertility Association(AFS)criteria,the patients in IUA group were divided into mild,moderate and severe group.The patients displayed normal uterine cavity morphology under hysteroscopy were as the control group(n=363).Both groups of patients underwent endometrial biopsy during surgery,and histological and CD138 immunohistochemical testing to evaluate CE status and analyze the relationship between CE prevalence,CE grading and IUA formation.The difference in the non-negative conversion rate of CE patients after one course of antibiotics treatment between the two groups,and the impact of CE non-cure on the outcome of IUA treatment was analyzed by multivariate logistic regression.Results:In the IUA group,the incidence of CE was 41.12%(162/394)and the cure rate was 83.59%(136/162)after one course of antibiotics treatment.Compared with the control group,the patients in the IUA group were older,had more pregnancies and miscarriages,more medical history such as previous biochemical pregnancy history,induced abortion history,natural abortion history,residual placenta tissue history,uterine mediastinal surgery history,and significantly higher incidence of CE(P<0.05).The above factors were analyzed by binary logistic regression analysis,and the results showed that presence of CE,number of previous pregnancies,history of induced abortion,history of spontaneous abortion,and history of uterine mediastinal surgery wer
作者
张明玮
刘倩
谢青贞
ZHANG Ming-wei;LIU Qian;XIE Qing-zhen(Center for Reproductive Medicine,Renmin Hospital of Wuhan University,Wuhan 430060)
出处
《生殖医学杂志》
CAS
2023年第6期823-828,共6页
Journal of Reproductive Medicine
基金
湖北省重点研发计划项目(2021BCA107)。
关键词
慢性子宫内膜炎
宫腔粘连
治疗结局
Chronic endometritis
Intrauterine adhesions
Treatment outcome
