子宫中隔切除术后预防粘连方法探讨

目的 探讨子宫中隔并不孕患者宫腔镜术后不同处理方法预防宫腔粘连的效果.方法 55例子宫中隔并不孕患者行腹腔镜监护下宫腔镜子宫中隔切除术(TCRS),术后针对不同患者采用不同术后处理措施,包括宫腔放置与不放IUD,是否进行人工周期治疗,部分患者术后使用GnRH-a类药物治疗术后第1、3个月行宫腔镜检查随访,宫内放置IUD的患者;于术后第3个月取环.结果 54例患者术后进行宫腔镜检查随访,其中40例分别于术后第1、3个月完成了术后2次宫腔镜检查,另14例只完成一次检查.宫腔术后放环与否对术后宫腔形态影响无差异(P>0.05),术后使用人工周期治疗患者较未使用者子宫内膜厚,此两者术后第3个月宫腔镜检查发现宫底创面均已有内膜覆盖.使用GnRH-a类药物患者术后官腔形态满意.结论 TCRS术后宫腔放置IUD无助于预防术后粘连的发生;术后人工周期治疗应更个体化并有针对性的使用GnRH-a类药物治疗.术后及时进行宫腔镜检查随访可防止术后宫底新粘连的形成.

Investigation of prevention of adhesion of post-operation of transcervical resecition of septa

ObJective To investigate the efficacy of different treatments applied to infertility patients with u-terine septa undergoing transcervical resection of septa to prevent the post-operation adhesion. Methods 55 infertili-ty patients with uterine septa underwent laparoscopy guidance transcervical resecition of septa(TCRS), different treatments were given to the patients post-operation, including placement of IUD in uterus cavity or not, artificial cy-cle treatment, GnRH-a medication using post-operation, hysteroscopy examination was performed for the first and third month post surgery and IUD was taken out in the third month post surgery. Results Total 54 eases completed hysteroscopy examination follow-up visits,of which 40 cases completed total two times of hysteroscopy in the first and third month, and 14 eases completed only once hysteroscopy examination. Whether or not placement of IUD hadno effect on uterus cavity shape(P > 0.05). Compared to eases without using artificial cycle treatment post-opera-tion, the endometrium was thicker in the cases with it post-operation. Both cases using and not using artificial cycle treatment were found to have endometrium covered in fundus under hysteroscopy in the third month post-operation.The satisfactory cavity shape was achieved on patient receiving GnRH-a medication. Conclusion Placement of IUD is not helpful in preventing the occurrence of post-operation adhesions. Individualized post-operation artificial cycle treatments should be applied to different patients and using GnRH-a medication should be in right direction. The hysteroscopy examination post-surgery should be given in time to prevent the new occurrence of adhesion in fundus post-operation.