龙文香++++++杨章莉++++++李蓉莹++++++周春慧

[摘要] 目的 探讨两种不同方法分离宫腔粘连的预后。 方法 将中重度宫腔粘连患者随机分为研究组（32例）和对照组（30例），研究组采用宫腔镜下微型剪刀切除术，对照组采用宫腔镜下电切术。两组术后均予上环术加透明质酸钠宫腔内注射及雌、孕激素人工周期治疗3个月；术后1、3个月行宫腔镜检查；术后6、18个月各进行随访1次。结果 研究组与对照组术后3个月宫腔形态恢复总有效率分别为90.6%（29/32）、93.3%（28/30）；月经改善总有效率分别为81.3%（26/32）、80.0%（24/30）；宫腔粘连的复发率分别为15.6%（5/32）、13.3%（4/30）；妊娠率分别为34.6%（9/26）、27.3%（6/22)；两组比较差异无统计学意义（P>0.05）。两组住院天数、手术费用、总费用比较差异有统计学意义（P<0.001）。两组均无明显的药物不良反应及手术并发症。 结论 两种不同方法分离宫腔粘连疗效无统计学差异，宫腔镜下微型剪刀切除术是一种值得临床推广的治疗方法。

[关键词] 宫腔粘连；宫腔镜；电切术；微型剪刀切除术；预后

[中图分类号] R713[文献标识码] A[文章编号] 1674-4721（2014）06（a）-0070-04

Clinical observation of two different methods of separation of intrauterine adhesions

LONG Wen-xiang YANG Zhang-li LI Rong-ying ZHOU Chun-hui▲

Maternal and Child Care Service Centre of Zhuzhou City in Hunan Province,Zhuzhou 412008,China

[Abstract] Objective To explore the prognosis of two different methods of separation of intrauterine adhesions. Methods Moderately severe intrauterine adhesions patients were randomly divided into two groups,the study group (32 cases) were given with micro scissors resection under hysteroscopy,the control group (30 cases) were given with hysteroscopic electric resection.Two groups of patients were treated with surgery combined with sodium hyaluronate on intrauterine injection of estrogen,progesterone and artificial cycle therapy for 3 months;after 1,3 months for hysteroscopy;after 6,18 months respectively were followed up 1 time. Results The uterine morphology recovery rate of study group and control group was 90.6% (29/32),93.3% (28/30) respectively;menstrual improvement rates were 81.3% (26/32),80.0% (24/30);recurrence of intrauterine adhesions were 15.6% (5/32),13.3% (4/30);pregnancy rate was 34.6% (9/26),27.3% (6/22) respectively; the two groups had no statistical difference (P>0.05).Two groups of hospitalization days,operation cost,total cost had significant difference (P<0.05).The two groups had no obvious adverse reaction and complication of operation. Conclusion Two different methods of separation of intrauterine adhesions effects has no statistical difference,micro scissors resection under hysteroscopy is worthy of clinical treatment.

[Key words] Intranuterine adhesion;Hysteroscopy;Electrocision;Micro scissors resection;Prognosis

随着改革开放的深入进行，人们的性观念发生了根本性改变，加上无痛人流技术的广泛应用，宫腔粘连（intranuterine adhesion，IUA）的发生率在逐年递增。方爱华[1]报道人工流产术后IUA发生率为0.6%。张运辉等[2]报道无痛人工流产组发生IUA比例为5.14%。2012年1～12月本院宫腔镜检查发现宫腔粘连的发生率为9.39%。宫腔镜下电切术是治疗中重度宫腔粘连的经典手术，需住院治疗，医疗费用高。为寻找一种更方便、更廉价的手术方法，本院2010年6月～2012年6月对62例中重度IUA患者采用不同方法进行宫腔粘连分离治疗的探讨，取得了较好的临床效果。

1 资料与方法

1.1 一般资料

选择2010年6月～2012年6月本院诊断中重度IUA患者共62例，其中人工流产术后26例，稽留流产清宫术后18例，药物流产不全及人流不全清宫术后8例，中孕引产清宫术后6例，足月分娩清宫术后3例，取环术后1例；闭……