重度宫腔粘连相关危险因素分析

目的探讨发生重度宫腔粘连(IUA)的相关危险因素,旨在为优化重度IUA的防治策略提供参考。方法选取2018年1月至2020年1月因IUA在西北妇女儿童医院住院治疗的576名患者,按照美国生育学会(AFS)评分标准将所有患者分为重度组(254例)和轻中度组(322例);收集患者的人口学特征资料、月经史、生育史、剖宫产史、药物流产史、人工流产史、清宫史、诊断性刮宫史、既往盆腔炎症史、既往宫腔镜手术史、生殖器结核病史及其相应发生次数等研究相关变量,运用Logistic回归模型回顾性分析发生重度IUA的相关危险因素。结果单因素分析显示,人工流产次数、稽留流产清宫次数、清宫总次数、黏膜下肌瘤电切术、瘢痕妊娠电切术、IUA电切术、足月分娩次数、宫腔操作总次数、引产次数及孕次与重度IUA的发生有关(OR值分别为1.357、2.013、1.257、0.789、0.786、2.218、0.426、1.561、0.277、1.246,均P<0.05)。多因素分析结果显示,足月分娩次数降低了重度IUA的发生风险(OR=0.376,P<0.05);人工流产次数越多、稽留流产次数越多、清宫次数越多的孕妇发生重度IUA的风险越大(OR值分别为2.439、2.234、2.266,均P<0.05)。结论足月分娩次数是发生重度IUA的保护因素;人工流产次数、稽留流产清宫次数及清宫总次数是发生重度IUA的危险因素。

Analysis of risk factors related to severe intrauterine adhesions

Objective To explore related risk factors of severe intrauterine adhesions(IUA),aiming to provide references for optimizing prevention and treatment strategies of severe IUA.Methods 576 patients who admitted to Northwest Women and Children’s Hospital from January 2018 to January 2020 due to IUA were selected.According to the AFS(American Fertility Society)scoring standard,the patients were divided into severe IUA group(254 cases)and mild to moderate IUA group(322 cases).The demographic data,menstrual history,childbearing history,cesarean section history,drug-introduced abortion history,artificial abortion history,uterine curettage history,diagnostic uterine curettage history,previous history of pelvic inflammation,previous history of hysteroscopic operation,history of genital tuberculosis of the patients and study-related variables such as corresponding occurrence times were collected.And logisitic regression model was used to retrospectively analyze the related risk factors of severe IUA.Results The single factor analysis showed that artificial abortion frequency,uterine curettage frequency due to missed abortion,total uterine curettage frequency,electrosection of submucosal leiomyoma of uterus,electrosection of intrauterine scarring pregnancy,electrosection of IUA,full-term delivery frequency,total frequency of intrauterine operations,induced abortion frequency and gravidity were all associted with severe IUA(OR=1.357,2.013,1.257,0.789,0.786,2.218,0.426,1.561,0.277 and 1.246 respectively,all P<0.05).Multiple factor analysis showed that frequency of full-term delivery reduced the risk of severe IUA(OR=0.376,P<0.05).And the more frequencies of artificial abortion,missed abortion and uterine curettage,the greater the risk of severe IUA(OR=2.439,2.234 and 2.266 respectively,all P<0.05).Conclusion Full-term delivery history is a protective factor of severe IUA,and frequency of induced abortions,frequency of uterine curettage due to missed abortion and total frequency of uterine curettage are risk factors of severe IUA.