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目的探讨以宫腔镜电切术为主的综合治疗方法对宫腔粘连(intrauterine adhesion,IUA)预后的影响。方法对2010年1月至2013年6月湖北省妇幼保健院因IUA行电切手术的218例患者临床资料进行回顾性分析。各程度IUA根据术后补充雌激素剂量和周期数不同分为3组,A组9 mg/d,服用3周期;B组6 mg/d,服用2周期;C组4 mg/d,服用1周期。观察3周期后月经恢复及宫腔情况并随访妊娠结局。结果宫腔恢复良好86.2%(188/218),月经改善75.7%(165/218);随访8~46个月,受孕44.5%(97/218),活产48.5%(47/97)。Ⅱ度与Ⅲ度IUA的宫腔恢复率、月经改善率差异无统计学意义(P>0.05),但二者与Ⅳ度以上IUA的宫腔恢复率、月经改善率差异均有统计学意义(P<0.05)。在相同程度IUA中A、B、C 3组比较,宫腔恢复率、月经改善率差异均无统计学意义(P>0.05)。结论以宫腔镜电切术为主的综合治疗方法对IUA治疗效果良好;轻、中度IUA预后明显好于重度IUA;适当减少雌激素剂量,缩短治疗周期对IUA预后无明显影响。
Objective To investigate the effect of combined treatment of hysteroscopic resection on the prognosis of intrauterine adhesion (IUA). Methods The clinical data of 218 patients who underwent resection by IUA from January 2010 to June 2013 in Hubei Maternal and Child Health Care Hospital were analyzed retrospectively. The degree of IUA according to postoperative estrogen dose and the number of cycles are divided into 3 groups, A group of 9 mg / d, taking 3 cycles; B 6 mg / d, taking 2 cycles; C 4 mg / d, taking 1 cycle. After 3 cycles of menstrual cycle recovery and uterine conditions and follow-up of pregnancy outcomes. Results The uterine cavity recovered well by 86.2% (188/218) and menstruation improved by 75.7% (165/218). The follow - up ranged from 8 to 46 months, with 44.5% (97/218) conceiving and 48.5% (47/97) live birth. There was no significant difference in uterine cavity recovery rate and menstrual improvement rate between IUA degree Ⅱ and Ⅲ degree (P> 0.05), but there was significant difference between IUA degree and uterine cavity recovery rate and menstrual improvement rate (P> 0.05) P <0.05). In the same degree of IUA in A, B, C group, uterine cavity recovery, menstrual improvement rate differences were not statistically significant (P> 0.05). Conclusions Hysteroscopic resection combined with IUA has a good effect on the treatment of IUA. The prognosis of mild and moderate IUA is better than that of severe IUA. Appropriate reduction of estrogen dose and shortening of treatment period have no significant effect on IUA prognosis.