两种宫腔镜手术方式治疗宫腔粘连后的妊娠结局分析

目的:探讨两种宫腔粘连分离手术方式的临床疗效及生殖预后。方法:回顾性分析2014年1月—2016年12月在中山大学附属第六医院生殖中心因宫腔粘连行宫腔镜手术治疗的患者40例,观察术后行体外受精胚胎移植时的子宫内膜厚度、妊娠情况及妊娠结局。结果:中度宫腔粘连25例,重度宫腔粘连15例。双极电针分离粘连组(电切组)19例,微型剪刀分离粘连组(剪刀组)21例。40例患者共助孕64个周期,电切组术后子宫内膜厚度为7.0(6.0~9.3)mm、薄型子宫内膜率为46.9%;剪刀组术后子宫内膜厚度8.0(7.0~9.8)mm、薄型子宫内膜率为31.3%,2组子宫内膜厚度及薄型子宫内膜率比较差异无统计学意义(P0.05)。电切组的种植率、临床妊娠率、活产率、流产率、继续妊娠率分别为46.9%、37.5%、18.8%、6.3%、12.5%,剪刀组分别为34.4%、28.1%、12.5%、3.1%、12.5%,2组比较差异均无统计学意义(P0.05)。电切组术后妊娠时间为7.5(4.0~12.0)个月,剪刀组为3.0(3.0~8.5)个月,差异有统计学意义(P0.05)。结论:宫腔镜下宫腔粘连分离术能改善患者的生殖预后,2种宫腔镜手术方式的妊娠结局无明显差异。

Reproductive Outcome Analysis of Two Kinds of Hysteroscopic Adhesiolysis

Objective:To analyze the efficacy and the reproductive outcome of hysteroscopic adhesiolysis. Methods:A total of 40 patients diagnosed with intrauterine adhesion received hysteroscopic adhesiolysis in The Sixth Affiliated Hospital of Sun Yat-Sen University from January 2014 to December 2016. The thickness of the endometrium and the reproductive outcome were observed. Results:Among the 40 patients (25 with moderate IUA, and 15 with severe IUA) who underwent hysteroscopic adhesiolysis, 19 cases use the bipolar electrode knife cutting adhesion, while 21 cases using micro-scissors. The reproductive outcome of 40 women underwent 64 assisted reproductive technology cycles were observed. The mean endometrial thickness and thin endometrium rate of the bipolar electrode knife group were 7.0 (6.0~9.3) mm and 46.9%, while 8.0 (7.0~9.8) mm and 31.3%in the micro-scissors group, no statistical significance was found between the two groups ( P>0.05). The implantation rate, conception rate, live birth rate, miscarriage rate and ongoing rate after hysteroscopic adhesiolysis in the bipolar electrode knife group were 46.9%, 37.5%, 18.8%, 6.3%and 12.5%, respectively, while in the micro-scissors group were 34.4%, 28.1%, 12.5%, 3.1%and 12.5%, respectively (P>0.05). The average conception time of bipolar electrode knife group was 7.5 (4.0~12.0) months longer than the micro-scissors group 3.0 (3.0~8.5) months, the difference reached statistical significance ( P<0.05). Conclusions:Hysteroscopic adhesiolysis is an effective and safe option for IUA patients that can improve the reproductive outcome, different methods of operation does not affect the reproductive outcome.