CAJ | 학술논문

目的探讨宫腔镜行宫腔粘连分离术后患者的妊娠结局及其相关影响因素。方法收集近年收治的，因宫腔粘连所致不孕，行宫腔镜下粘连分离术68例患者的临床资料，随访患者术后的妊娠结局，选择宫腔粘连性质、范围、程度、术后月经恢复、宫内节育器、人工周期及术后年限等7个因素进行妊娠结局的相关性分析。结果术后妊娠率为66.2%（45/68），难免流产3例5例次，输卵管妊娠1例，获得存活胎儿妊娠41例42例次，获得存活胎儿的有效妊娠率为61.8%（42/68）。42例次有效妊娠中，1例孕34周早产，5例胎位异常，1例妊娠合并肝内胆汁淤积症，1例帆状胎盘伴胎盘粘连，3例先兆流产同时合并胎盘粘连2例，剖宫产率为73.8%（31/42）。统计学分析显示，获得存活胎儿的概率与术后月经是否恢复正常、术后年限直接相关（均P＜0.05）。结论宫腔粘连所致不孕患者行宫腔镜下粘连分离术后应着重恢复正常月经，并积极争取术后1年内的最佳时间妊娠，以获得好的妊娠结局，术后妊娠者应视为高危人群。
목적탐토궁강경행궁강점련분리술후환자적임신결국급기상관영향인소。방법수집근년수치적，인궁강점련소치불잉，행궁강경하점련분리술68례환자적림상자료，수방환자술후적임신결국，선택궁강점련성질、범위、정도、술후월경회복、궁내절육기、인공주기급술후년한등7개인소진행임신결국적상관성분석。결과술후임신솔위66.2%（45/68），난면유산3례5례차，수란관임신1례，획득존활태인임신41례42례차，획득존활태인적유효임신솔위61.8%（42/68）。42례차유효임신중，1례잉34주조산，5례태위이상，1례임신합병간내담즙어적증，1례범상태반반태반점련，3례선조유산동시합병태반점련2례，부궁산솔위73.8%（31/42）。통계학분석현시，획득존활태인적개솔여술후월경시부회복정상、술후년한직접상관（균P＜0.05）。결론궁강점련소치불잉환자행궁강경하점련분리술후응착중회복정상월경，병적겁쟁취술후1년내적최가시간임신，이획득호적임신결국，술후임신자응시위고위인군。
Objective To evaluate reproductive outcomes after hysteroscopic resection of intrauterine adhesions. Meth-ods The reproductive outcomes of 68 patients with intrauterine adhesions who underwent hysteroscopic adhesiolysis were ret-rospectively analyzed. The factors related to pregnancy outcome were analyzed, including the type, area, degree of adhesion, postoperative resumption of menstruation, IUD usage, artificial menstrual cycle and fol ow- up time. Results Forty five preg-nancies were achieved in 68 patients (66.2%), including 42 childbirths, 5 spontaneous abortions and 1 tubal ectopic pregnancy. Forty two viable infants were delivered in 41 cases (61.8%), including 1 case of premature delivery in 34 pregnancy weeks, 5 abnormal fetal position, 1 intrahepatic cholestasis, 3 threatened abortion accompanied with placenta adhesions;and the rate of cesarean section is 73.8%(31/42). The pregnancy outcome was associated with resumption of menstruation and postoperative time(P<0.05). Conclusion The results suggest that resumption of menstruation and pregnancy within 1 year after hysteroscopic adhesiolysis are important to acquire favorable pregnancy outcome for patients with intrauterine adhesions.