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目的探讨子宫内膜结核引起的宫腔黏连的治疗和预后。方法回顾性分析2008年10月至2012年4月首都医科大学附属复兴医院行宫腔镜宫腔黏连分离术(TCRA)的患者36例,均为子宫内膜结核所致的宫腔黏连。平均年龄(31±3.14)岁(24～38岁)。原发不孕35例(97.2%),继发不孕1例(2.8%)。原发闭经8例(22.2%),继发闭经3例(8.3%),月经量减少25例(69.4%)。30例既往有其他器官结核病诊治史,中度黏连19例(52.8%),重度黏连17例(47.2%),25例入院前曾行TCRA1～4次。TCRA术后均给予大剂量雌激素连续或周期性辅助治疗,观察术后宫腔形态恢复、月经及妊娠状况。结果随访6～42个月,4例失访。32例术后3个月复查,14例(43.8%)宫腔形态恢复正常,18例(56.2%)均发生不同程度的再次黏连,其中8例(25%)再行TCRA术。术后6个月仅19例月经改善(59.4%),其中5例闭经患者(占闭经患者45.5%)恢复少量月经,另14例经量较术前稍多。20例试妊娠,均未成功,7例行体外受精-胚胎移植(IVF-ET)共18次,妊娠2次,但均于孕早期流产。结论结核性宫腔黏连经过TCRA及相关辅助治疗后预后差,内膜生长不良,妊娠困难,应尽早行IVF-ET。预防及尽早治疗子宫内膜结核非常重要。
Objective To investigate the treatment and prognosis of uterine adhesions caused by endometrial tuberculosis. Methods Thirty-six patients with hysteroscopic adhesions (TCRA) from Fuxing Hospital attached to Capital Medical University from October 2008 to April 2012 were retrospectively analyzed. All of them were intrauterine adhesions caused by endometrial tuberculosis. The average age (31 ± 3.14) years (24 to 38 years old). 35 cases of primary infertility (97.2%), 1 case of secondary infertility (2.8%). There were 8 cases (22.2%) of primary amenorrhea, 3 cases of secondary amenorrhea (8.3%) and 25 cases (69.4%) of menstruation. Thirty patients had previous diagnosis and treatment of tuberculosis in other organs. There were 19 cases (52.8%) with moderate adhesions and 17 cases (47.2%) with severe adhesions. TCRA was performed 1 ~ 4 times before admission in 25 cases. TCRA were given high-dose estrogen continuous or periodic adjuvant therapy, postoperative uterine morphology recovery, menstruation and pregnancy status. Results The follow-up ranged from 6 to 42 months. Four patients were lost to follow-up. Thirty-two cases were retrospectively studied at 3 months after operation. The morphology of uterine cavity in 14 cases (43.8%) returned to normal, and 18 cases (56.2%) were reattached in varying degrees. TCRA was performed in 8 cases (25%). In the 6 months after operation, only 19 cases improved their menstruation (59.4%). A small amount of menstruation was recovered in 5 cases of amenorrhea patients (45.5% of amenorrhea patients), and the other 14 cases were slightly more than those before operation. 20 cases of pregnancy test, were unsuccessful, 7 cases of IVF-ET were 18 times, 2 pregnancies, but were aborted in early pregnancy. Conclusion Tuberculous uterine adhesions after TCRA and related adjuvant therapy poor prognosis, poor endometrial growth, difficult pregnancy, as soon as possible IVF-ET. Prevention and early treatment of endometrial tuberculosis is very important.