CAJ | 학술논문

目的：探讨宫腔镜诊治宫腔粘连（IUA）的临床效果及预后。方法分析重庆市荣昌县人民医院妇产科2008年6月至2013年11月诊治的300例IUA患者的病历资料，做宫腔镜检查确诊为IUA，并行宫腔镜下宫腔粘连刮匙分离术（TCRA），术后给予人工周期（雌孕激素）及宫内放置节育器治疗3个月后行宫腔镜二探及近远期随访。结果300例IUA患者中，243例（81．00％）患者出现不同程度的月经量减少及闭经；238例（79．33％）有宫腔操作史，其中因早期妊娠人工流产所致179例（75．21％），稽留流产清宫所致65例（27．31％）；术后月经周期（3个月月经周期）宫腔镜检查形态恢复正常或基本正常者289例（96．33％），其中术后月经量恢复正常或较术前增多者162例（54．00％），无变化者97例（32．33％），减少者41例（13．67％）；随访患者216例（随访率72．00％），有生育要求患者152例，其中术后妊娠123例（妊娠率80．92％），自然流产19例（流产率12．50％），足月产98例（足月产率64．47％），早产6例（早产率3．95％），产时胎盘因素并发症（胎盘粘连、胎盘植入）发生98例（44．34％）。结论妊娠后刮宫是IUA的主要原因；宫腔镜是目前诊治IUA最准确、最理想的方法；预防宫腔粘连最根本办法还是要减少人工流产、规范人工流产的手术操作；重度IUA预后欠佳，再粘连预防和生育预后面临挑战。
목적：탐토궁강경진치궁강점련（IUA）적림상효과급예후。방법분석중경시영창현인민의원부산과2008년6월지2013년11월진치적300례IUA환자적병력자료，주궁강경검사학진위IUA，병행궁강경하궁강점련괄시분리술（TCRA），술후급여인공주기（자잉격소）급궁내방치절육기치료3개월후행궁강경이탐급근원기수방。결과300례IUA환자중，243례（81．00％）환자출현불동정도적월경량감소급폐경；238례（79．33％）유궁강조작사，기중인조기임신인공유산소치179례（75．21％），계류유산청궁소치65례（27．31％）；술후월경주기（3개월월경주기）궁강경검사형태회복정상혹기본정상자289례（96．33％），기중술후월경량회복정상혹교술전증다자162례（54．00％），무변화자97례（32．33％），감소자41례（13．67％）；수방환자216례（수방솔72．00％），유생육요구환자152례，기중술후임신123례（임신솔80．92％），자연유산19례（유산솔12．50％），족월산98례（족월산솔64．47％），조산6례（조산솔3．95％），산시태반인소병발증（태반점련、태반식입）발생98례（44．34％）。결론임신후괄궁시IUA적주요원인；궁강경시목전진치IUA최준학、최이상적방법；예방궁강점련최근본판법환시요감소인공유산、규범인공유산적수술조작；중도IUA예후흠가，재점련예방화생육예후면림도전。
Objective To discuss the efficacy and prognosis of hysteroscopy in the intrauterine adhesion diag-nosis and treatment .Methods 300 cases with intrauterine adhesion were enroued in this cohort study ,who were di-agnosed by hysteroscopy in our hospital from June 2008 to November 2013 and underwent trans cervical resection of adhesions or curet separation operation ,then accepted oral estrogen and installed intrauterine device post the opera-tion .Three months later ,all patients underwent second-look hysteroscopy and the recent and long-term follow-up was analyzed .Results In the 300 patients with intrauterine adhesions ,243 patients (81 .00% ) occured varying degrees of menstrual quantity decreases and amenorrhea ,among them 238 cases (79 .33% ) with a history of uterine cavity oper-ation ,while 179 patients (75 .21% ) underwent induced abortion during the early pregnancy ,65 cases (27 .31% ) car-ried out complete curettage of uterine cavity because of missed abortion .In 289 patients (96 .33% ) with uterus recov-ered to normal or almost normal examined by hysteroscopy after three times menstrual cycles ,there are 162 cases (54 .00% ) got normal menstrual or obviously better than pre-operation ,with 97 patients (32 .33% ) had no change in the period ,41 patients (13 .67% ) got menstrual quantity decreased .In the 216 cases followed up ,there were 123 ca-ses got pregnancy of the 152 patients who had fertility requirements ,spontaneous abortion accounted for 19 cases (12 .50% ) ,98 cases (64 .47% ) of term delivery and 6 cases (3 .95% ) of premature delivery .There were 98 cases (44 .34% ) occurred complications related to placental factors during the delivery ,such as adherent placenta and pla-centa implantation .Conclusion Uterine curettage after the pregnancy is the major reason results in intrauterine adhe-sion ,hysteroscope is the most accurate and perfect way to diagnose and treat intrauterine adhesion .The basic strategy to prevent intrauterine adhesion is to reduce induced abortion and normalize the operation .Patients with severe intra-uterine adhesion has bad prognosis ,it is a challenge to prevent recurrence and get pregnancy .