宫腔镜治疗宫腔粘连64例临床分析

张磊，陈灿明，胡金菊

扬州市妇幼保健院妇科，江苏扬州225000

[摘要]目的探讨以宫腔镜为主的综合治疗在度宫腔粘连病例中的应用价值。方法回顾性分析2012年1月—2014年12月该院64例宫腔粘连病例以宫腔镜手术治疗的疗效。结果64例宫腔镜术后36例恢复正常月经，占56.25%(36/64)；21例月经改善，占32.81%(21/64)；7例月经无改善或仍闭经，占10.94%(7/64)。结论宫腔镜对于宫腔粘连的治疗是有效的,尤其是轻中度患者。使用宫腔镜联合超声是手术安全成功的保障，宫腔镜术后宫腔内放置Foley导尿管，术后的雌孕激素周期治疗促进子宫内膜修复、宫腔放置合适的宫内节育器均有利于预防术后宫腔再粘连。

[关键词]宫腔粘连；宫腔镜；宫腔重建

[中图分类号]R117

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0098-03

Abstract[]Objective To explore on the application value of hysteroscopy-based comprehensive therapy in the treatment of intrauterine adhesion.Methods A retrospective study was made on 64 intrauterine adhesion patients admitted to our hospital from January 2012 to December 2014 who underwent hysteroscopy-based comprehensive therapy to evaluate their therapeutic effects.Results Of all the 64 patients, normal menstruation in 36 patients was reported after the surgery, accounting for 56.25%; menstruation was improved in 21 patients, accounting for 32,81%; 7 patients showed no sign of improvement, accounting for 10.94%.Conclusion Hysteroscopy-based comprehensive therapy is effective in treating patients with intrauterine adhesion, especially for those with mild and moderate intrauterine adhesion.Hysteroscopy combined with ultrasound can safeguard a successful operation, while placement of Foley catheter in uterine cavity, periodic treatment of estrogen and progestogen to promote endometrial repair, placement of suitable intrauterine contraceptive device can all be beneficial for preventing postoperative intrauterine re-adhesions.[Key words]Intrauterine adhesion; Hysteroscopy; Uterus reconstruction

收稿日期：（2015-07-11）

Hysteroscopy-based Comprehensive Therapy in the Treatment of Intrauterine Adhesion：An Analysis of 64 Cases

ZHANG Lei, CHEN Can-ming, HU Jin-ju

Department of Gynecology, Yangzhou Maternal and Child Care Service Centre, Yangzhou, Jiangsu Province, 225000 China

宫腔粘连在临床上是妇科常见病种之一，近年来，随着人工流产术的逐年增多尤其无痛人流的增多，宫腔粘连( Intra－uterine adhesions，IUA)的发病率有明显增加的趋势[1]。目前，宫腔镜是诊治宫腔粘连的最好的方法，该研究整群选取该院2012年1月—2014年12月收治的64例宫腔粘连病例进行回顾性分析，现报道如下。

1　资料与方法

1.1一般资料

该组患者64例，年龄18～42岁，平均（28.12±4.31）岁，闭经患者18例，经量减少46例，62例（96.88%）患者有宫腔操作史，其中稽留流产清宫18例，人流术17例，中孕引产后清宫11例，药流后清宫6例，葡萄胎吸宫术4例，宫腔镜子宫肌瘤切除术后2例，宫腔镜子宫内膜息肉切除术后2例，诊刮术后1例，取环术后1例。47例（75.81%）患者为麻醉后手术；经B超及子宫输卵管造影检查提示宫腔粘连13例，后经宫腔镜确诊，其余51例直接经宫腔镜检查确诊。……