75例宫腔镜下中-重度宫腔粘连电切术后妊娠结局临床分析
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摘要
目的分析宫腔镜下中-重度粘连患者电切术后妊娠结局。方法选择广州医科大学附属第三医院妇科2009年1月-2016年4月94例宫腔中-重度粘连实施超声监护下宫腔镜电切手术患者,随访患者术后妊娠结局。结果术后共随访到75例患者妊娠结局,术后0～6个月内妊娠率为29.3%(22/75),分娩率为68.2%(15/22)。7～12个月内妊娠率为15.0%(9/60),分娩率为55.6%(5/9)。13～18个月内妊娠率为7.3%(4/55),分娩率为75.0%(3/4)。19～24个月内妊娠率为9.6%(5/52),分娩率为80.0%(4/5),术后不同时限内各组妊娠率比较均有统计学意义(P=0.003)。结论宫腔粘连术后采取人工周期治疗联合宫内节育器放置,二次探查宫腔无明显妊娠禁忌后,术后半年内为妊娠最好时间窗,分娩结局无明显差异,具有重要的临床随访指导价值。
Objective To analyze the clinical features of pregnancy outcome for patients with of moderate-severe intrauterine adhesions after resection under hysteroscopy. Methods Form 2009 January to 2016 April, 94 patients with intrauterine adhesions performed hysteroscopy surgery under ultrasound monitoring were selected to follow up postoperative outcome. Results In postoperative follow-up of 75 patients with pregnancy and birth outcomes, the pregnancy rate within 6 months after operation was 29.3%(22/75), the delivery rate was 68.2%(15/22); the pregnancy rate within 6-12 months was 15.0%(9/60), the delivery rate was 55.6%(5/9); the pregnancy rate within 12-18 months was 7.3%(4/55), the delivery rate was 75.0%(3/4); the pregnancy rate within 18-24 months was 9.6%(5/52), the delivery rate was 80.0%(4/5). Pregnancy rates were statistically significant in all groups at different time limits(P=0.003). Conclusion After intrauterine adhesion was treated with artificial cycle treatment combined with Intra-Uterine Device placement, there was no obvious pregnancy contraindications in the second exploration of intrauterine, and the best time window of pregnancy was within half a year after operation, and there was no significant difference in delivery outcome. It has important clinical follow-up guiding value.
Objective To analyze the clinical features of pregnancy outcome for patients with of moderate-severe intrauterine adhesions after resection under hysteroscopy. Methods Form 2009 January to 2016 April, 94 patients with intrauterine adhesions performed hysteroscopy surgery under ultrasound monitoring were selected to follow up postoperative outcome. Results In postoperative follow-up of 75 patients with pregnancy and birth outcomes, the pregnancy rate within 6 months after operation was 29.3%(22/75), the delivery rate was 68.2%(15/22); the pregnancy rate within 6-12 months was 15.0%(9/60), the delivery rate was 55.6%(5/9); the pregnancy rate within 12-18 months was 7.3%(4/55), the delivery rate was 75.0%(3/4); the pregnancy rate within 18-24 months was 9.6%(5/52), the delivery rate was 80.0%(4/5). Pregnancy rates were statistically significant in all groups at different time limits(P=0.003). Conclusion After intrauterine adhesion was treated with artificial cycle treatment combined with Intra-Uterine Device placement, there was no obvious pregnancy contraindications in the second exploration of intrauterine, and the best time window of pregnancy was within half a year after operation, and there was no significant difference in delivery outcome. It has important clinical follow-up guiding value.
引文
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[10] JOHARY J,XUE M,ZHU X,et al.Efficacy of estrogen therapy in patients with intrauterine adhesions:systematic review[J].Minim Invasive Gynecol,2014,21(1):44-54.
[11] 牟晓玲,唐良萏,曹毅.宫腔镜诊治110例宫腔粘连的临床分析[J].重庆医学,2011,40(16):1568-1569.
[12] 付熙,艾星子·艾里,丁岩.宫腔镜联合超声监护在子宫纵隔电切手术中的应用价值[J].新疆医科大学学报,2010,33(10):1262-1264.
[13] KODAMAN P H,ARICI A.Intra-uterine adhesions and fertility outcome:how to optimize success?[J].Curt Opin Gynecol,2017,19(3):207-214.
[14] 曲军英,王丽华,庄丽娟,等.宫腔粘连的宫腔镜评价与临床疗效分析[J].中国内镜杂志,2012,18(12):1269-1272.
[2] REBECCA R,ABBOTT J.Review of intrauterine adhesions[J].J Minimal Invasive Gynecol,2015,17(5):555-569.
[3] ROBINSON J K,ISAACSON K B.Postoperative adhesiolysis therapy for intrauterine adhesions(Asherman’S syndrome)[J].Fertil Steril,2012,90(8):409-414.
[4] REYNOLDS R K,BURKE W M.Application of ultrasonography combined with hysteroscopy in the middle and lower segment of intrauterine adhesions[J].Minim Invasive Gynecol,2015,22(6S):S190.
[5] 常亚杰,张祖威,陈玉清.中重度宫腔粘连电切术后辅以人工周期治疗临床疗效观察[J].中山大学学报(医学科学版),2013,34(1):104-108.
[6] NEIL J S,DAVID B L.Human amnion as a temporary biologic barrier after hysteroscopic lysis of severe intrauterine adhesions:pilot study[J].Minim Invasive Gynecol,2016,17(5):605-611.
[7] 陈运红,蒋依玲,苏莉,等.不同剂量戊酸雌二醇用于子宫纵隔切除术术后预防宫腔粘连[J].医药导报,2016,35(6):604-608.
[8] NOE N L,ISSA K B.Review of outcomes of patients treated for intrauterine adhesions with office hysteroscopy and hormone replacement therapy[J].Minim Invasive Gynecol,2015,22(6S):S184-S185.
[9] 李烨,张艳萍,朱玉钊.宫喜环对育龄妇女避孕的效果的临床研究[J].泰山医学院学报,2014,35(6):534-535.
[10] JOHARY J,XUE M,ZHU X,et al.Efficacy of estrogen therapy in patients with intrauterine adhesions:systematic review[J].Minim Invasive Gynecol,2014,21(1):44-54.
[11] 牟晓玲,唐良萏,曹毅.宫腔镜诊治110例宫腔粘连的临床分析[J].重庆医学,2011,40(16):1568-1569.
[12] 付熙,艾星子·艾里,丁岩.宫腔镜联合超声监护在子宫纵隔电切手术中的应用价值[J].新疆医科大学学报,2010,33(10):1262-1264.
[13] KODAMAN P H,ARICI A.Intra-uterine adhesions and fertility outcome:how to optimize success?[J].Curt Opin Gynecol,2017,19(3):207-214.
[14] 曲军英,王丽华,庄丽娟,等.宫腔粘连的宫腔镜评价与临床疗效分析[J].中国内镜杂志,2012,18(12):1269-1272.