宫腔镜在诊治人工流产术后宫颈粘连及术后二次探查中的价值

目的 探讨宫腔镜诊治人工流产术后宫颈粘连及术后二次探查的价值.方法 2000年12月～ 2012年7月51例人工流产术后有症状者行宫腔镜检查,对宫颈和宫腔粘连进行分离、切除,术后宫腔内放置带尾丝的节育器.对术后第3次月经干净3～7d行宫腔镜二次探查.结果 人工流产术后宫颈粘连中有9.8％(5/51)的病人同时合并宫腔粘连.宫颈粘连中疏松粘连占72.5％ (37/51),致密粘连占27.5％ (14/51).术后二次探查显示疏松粘连组复发率2.7(1/37)与致密粘连组21.4％ (3/14)无统计学差异(x2=2.677,P=0.102);宫颈粘连合并宫腔粘连组复发率60.0％ (3/5)显著高于单纯宫颈粘连组2.2％ (1/46) (P =0.002).结论 宫腔镜诊治人工流产术后宫颈粘连有较高的临床应用价值,宫腔镜二次探查可以了解宫腔恢复情况,确定治疗是否彻底和发现粘连及早分离,弥补第1次手术的不足.

The Value of Hysteroscope in the Diagnosis and Treatment of Cervix Adhesion after Induced Abortion and Postoperative Secondary Exploration

Objective To evaluate the value of hysteroscope in the diagnosis and treatment of cervix adhesion after induced abortion and postoperative secondary exploration.Methods 51 patients with symptoms after induced abortion underwent hysteroscopic examination from December 2000 to July 2012.Cervix and intrauterine adhesion were separated and dissected.Intrauterine device was inserted after operation.Postoperative secondary hysteroscopic examination was performed 3 to 7 days after the third menstruation.Results After artificial abortion,9.8%（5/51）of patients with cervical adhesions were combined with intrauterine adhesion.Among the patients with cervical adhesion,loose adhesions accounted for 72.5%（37/51）,and dense adhesions accounted for 27.5%（14/51）.Postoperative hysteroscopic examination showed that the loose adhesion group（2.7,1/37） had similar recurrence rate to the dense adhesion group（21.4%,3/14）（χ^2=2.677,P=0.102）.The cervical adhesions combined with intrauterine adhesions group（60.0%,3/5） had significantly higher recurrence rate than that of the simple cervical adhesion group（2.2%,1/46）（P=0.002）.Conclusions Hysteroscope has clinical value in the diagnosis and treatment of cervix adhesion after induced abortion.Postoperative secondary hysteroscopic exploration helps doctors to learn about uterine recovery to make early decisions about the second surgery.