宫腹腔镜联合诊治宫腔粘连的临床分析

目的探讨宫腹腔镜联合手术结合术后系统防粘连治疗在诊断和治疗宫腔粘连中的意义。方法回顾分析本院妇产科2003年1月至2007年12月宫腔镜下宫腔粘连分离术患者156例。以宫腔镜联合腹腔镜诊断结果为标准，分析子宫输卵管造影（HSG）和超声检查的诊断效果。随访术后妊娠率、活产率及术后妊娠间隔时间。结果（1）HSG和B超检查对宫腔粘连的阳性诊断率分别为62．5％和60．5％，漏诊率分别为30．2％和32．6％，误诊率分别为7．3％和7．0％。腹腔镜检查提示〉70％宫腔粘连患者合并盆腔疾病。（2）术后随访1～2年，共追踪到80例患者，术后妊娠率为36．2％，活产率52．0％。术后平均妊娠间隔时间2～16个月，平均（7．2±3．3）个月，术后6个月内妊娠流产率高于6个月后妊娠（P〈0．05）。结论HSG和超声检查作为不育症的常规检查，对诊断宫腔粘连有一定的价值，但有一定的漏诊率和误诊率。宫腔镜手术是有效的诊断和治疗方法，联合腹腔镜手术有利于提高妊娠率。宫腔镜粘连分离术后4～10个月妊娠几率最高，术后6个月后妊娠结局优于术后6个月内妊娠，合适的妊娠时机仍需要进一步探讨。

Clinical analysis of intrauterine adhesions after hysteroscopy surgery

Objective： To evaluate the diagnosis and treatment value by using hysteroscopy and laparoscopy combined with systemic anti-adhesion treatment in intrauterine adhesions. Methods： Retrospective analysis of 156 women with intrauterine adhesions performed by hysteroscopic resection. According to the results of the hysteroscopic and laparoscopic, the diagnosis value of hysterosalpingogram （HSG） and ultrasonography were evaluated. The reproductive outcome and the interval of conceive of patients were followed up. Results： 1. According to diagnosis results with the combined hysteroscopic and laparoscopic for intrauterine adhesions, the positive predictive values of HSG and ultrasonography were 62. 5% vs. 60. 5%, the missed diagnosis rates were 30.2% vs. 32. 6%, the misdiagnosis rates were 7.3% vs. 7.0%. The result of laparoscopic examination suggested that above 70% of intrauterine adhesions cases were combined pelvic disease. 2. Eighty cases of intrauterine adhesions were followed up for one to two years, the pregnancy rate was 36.2% and the live birth rate was 52.0%. The interval of conceive after operation was 2 to 16 months, and the mean interval was 7.2±3.3 month. The abortion rate of patients conceived within the 6 months of operation was higher than that of the patients conceived after the 6 months （P〈0. 05）. Conclusions. As the routine examination, HSG and ultrasonography were useful in the diagnosis of the intrauterine adhesions, but both of them had omission and false diagnosis. Hysteroscopic surgery was efficient and safe in diagnosis and treatment of the intrauterine adhesions, and combined with laparoscopic surgery could increase the pregnancy rate. After hysteroscopic adhesiolysis, most of the patients conceived in 4-10 months. And the pregnancy outcomes were better in the patients conceived 6 months after operation than the patients conceived within 6 months.