宫腔镜子宫中隔切除术后3种治疗方法预防宫腔粘连的疗效及生殖预后观察

目的:探讨宫腔镜下子宫中隔切除(transcervical resection of septum,TCRS)术后预防宫腔粘连形成及改善妊娠结局的最佳治疗方案。方法:TCRS术后患者116例随机分为4组:A组(n=30),术后行人工周期;B组(n=31),术后宫腔放置宫内节育器(IUD);C组(n=27),术后放置IUD+行人工周期;D组(n=28),术后不采取任何干预措施。术后3个月再次行宫腔镜检查,观察宫腔是否发生粘连及粘连分布,随访至术后24个月,记录月经恢复情况及妊娠结局。结果:A组排除9例(6例失访,3例漏服药物),B组排除6例(4例失访,2例IUD脱落),C组排除2例(1例失访,1例IUD下移),D组排除5例(均为失访)。4组术后3个月宫腔粘连发生率依次为:14.2%(1/7)、37.5%(3/8)、22.2%(2/9)、9.1%(1/11);随访至术后24个月,妊娠率分别为:33.3%(7/21)、32.0%(8/25)、36.0%(9/25)、47.8%(11/23);流产率分别为:4.8%(1/21)、12.0%(3/25)、8.0%(2/25)、4.3%(1/23),宫腔粘连发生率、妊娠率和流产率组间均无统计学差异(P>0.05)。结论:TCRS术后进行人工周期、IUD、IUD+人工周期3种治疗方法对防止宫腔粘连形成及提高妊娠率、改善妊娠结局方面无明显益处,且治疗效果差别不大,术后不必将其作为常规治疗方法。

Exploration of the Prevention and Management Strategy for Intrauterine Adhesions after Hysteroscopic Uterine Septum Resection

Objective: To investigate the strategy for how to improve the pregnancy rate and prevent intrauterine adhesions after transcervical resection of septum(TCRS).Methods: After TCRS 116 women were divided into 4 groups randomly.Group A received hormone treatment(n=30),group B received an IUD treatment(n=35),group C received both of above(n=27) and group D received no treatment(n=28).Most were checked hysteroscopically 3 months after TCRS.All pregnancies occurring during the study period were recorded.Results: Of the 116 original participants,22 were excluded: 9 in group A(6 were lost to followup and 3 received discontinuing treatment);6 in group B(4 were lost to follow-up and 2 had their IUD removed because of severe bleeding and pain);2 in group C(1 were lost to follow-up and 1 had IUD displacement);4 in group D who were lost to follwo-up.In group A,group B,group C and group D,adhesion rates at 3 months after operation were 14.2%(1/7),37.5%(3/8),22.2%(2/9),9.1%(1/11),respectively;pregnancy rates at 24 months after operation were 33.3%(7/21),32.0%(8/25),36.0%(9/25),47.8%(11/23),respectively;abortion rates were 4.8%(1/21),12.0%(3/25),8.0%(2/25),4.3%(1/23),respectively.There were no differences in adhesion rate,pregnancy rate and abortion rate among the 4 groups(P>0.05).Conclusion: Neither hormone,nor IUD placement,or both of above were found to be different in the prevention of intrauterine adhesions or in the outcome of pregnancy after TCRS.