宫腔镜在宫腔粘连诊断和治疗中的应用价值

目的评价宫腔镜下不同手术方式在治疗宫腔粘连中的价值.方法回顾性分析146例因宫腔粘连行诊断性宫腔镜或治疗性宫腔镜手术治疗效果.结果宫腔粘连Ⅰ度为36.3%,Ⅱ度25.3%,Ⅲ度 19.2%,Ⅳ度 13.7%,V度 5.5%.行诊断性宫腔镜分离粘连者21.9%(32例).治疗性宫腔镜手术分离粘连者占78.1%(114例),其中采用微型剪刀法78例(68.4%),电切法30例(26.3%),联合应用6例(5.3%).90.41%(132例)粘连一次分离完全,9例行二次宫腔镜手术分离粘连成功,总成功率达96.6%(142/146).87例有生育要求的患者,经治疗后妊娠者87.4%(76例),其中宫外孕占1.3%(1例).结论宫腔镜对于治疗不同程度的宫腔粘连具有重要的价值,可以有效的分离宫腔粘连,提高妊娠率.

The Advantage of hysteroscopy in diagnostic and therapeutic intrauterine adhesion

Objective To evaluate the value of hysteroscopy in the diagnosis and surgical treatment of intrauterine adhesion(IA).Methods The postoperative effectiveness of 146 cases with intrauterine adhesion by diagnostic hysteroscopy and therapeutic hysteroscopy were analysised retrospectively. Results After hysteroscopy treatment, IA with degree I to V were found 36.3%,25.3%,19.2%, 13.7%,5.5%, respectively. There were 21.9%(32cases) were detached by diagnostic hysteroscopy and 62.5%(20cases) were separated completely. There were 78.1%(114cases)patients were used therapeutic hysteroscopy to detached the adhesion,in which 68.4%(78cases)with the methods of micro-scissors and 26.3%(30cases) with the methods of electric excision and 5.3%(6cases)with the two methods combination. There were 9 cases were done the operation under the supervision of ultrasonography or laparoscopy. 90.41%(132 cases)of patients with IA were detached completely in once operation and 9 patients were operated for twice time. The total successful rate of operation were 96.6%(142/146). Among the 87 patients who want to be pregnant, 87.4% (76/87) women achieved pregnancy; of those, 68 cases achieved a term pregnancy, and 1case with ectopic pregnancy. Conclusion It is good method for patients with different degree intrauterine adhesion to choose hysteroscopy to separate adhesion and improve the pregnant rate.