493例宫腔粘连患者的临床资料分析

目的:探讨宫腔粘连(IUA)患者粘连程度的高危影响因素。方法:回顾2012年1月至2014年6月北京大学第三医院生殖医学中心经宫腔镜确诊的493例IUA患者的临床资料,根据粘连程度分组,分析影响粘连程度的相关因素。结果:不同粘连程度IUA患者的平均年龄、月经周期和中孕妊娠丢失情况比较,差异均无统计学意义(P0.05);不同粘连程度IUA患者的月经量、原发不孕几率、结核病史和内膜炎情况均存在显著差异(P0.05);随着粘连程度的增加,经量减少、原发不孕及结核病史的患者所占的比例逐渐增加,而合并内膜炎患者的比例呈下降趋势。IUA粘连程度与妊娠相关的宫腔操作有关(P0.05),随着宫腔操作次数的增加,Ⅲ~Ⅴ度IUA患者明显增加。41.48%的IUA患者的子宫内膜超声结果正常,不同粘连程度患者的超声表现存在显著差异(P0.001),但随着粘连程度的加重,超声确诊粘连的比例无上升趋势。444例Ⅰ~Ⅲ度IUA患者中,内膜受损部位以中部居多,占45.05%;按粘连程度分组后,各组粘连部位存在统计学差异(P0.001),宫腔右侧粘连的比例明显高于左侧。结论:积极治疗感染性疾病,尽量减少宫腔创伤性操作,有助于避免IUA的发生;二维超声诊断IUA的敏感性低,宫腔镜检查是诊断IUA的金标准。

Clinical analysis of 493 intrauterine adhesions cases

Objective:To explore the high risk factors of adhesion types in patients with intrauterine adhesions (IUA),and to provide reference for its diagnosis and prevention.Methods:493 cases of IUA were included from Jan.2012 to June 2014 in Reproductive Medical Center of Peking University Third Hospital.All cases were grouped according to the degree of IUA.The factors that affect the degree of adhesion were analyzed.Results:There was no significant difference in the mean age,menstrual cycle and the loss of middle pregnancy between different levels of IUA (P>0.05).There were significant differences in the number of patients,the risk of primary infertility,the history of tuberculosis and the presence of endometriosis (P<0.05).With the increase of the degree of adhesion,the proportion of patients with reduced volume,primary infertility and tuberculosis was gradually increased,while the proportion of patients with endometriosis showed a downward trend.The density of IUA was associated with intrauterine procedures related to pregnancy (P<0.05).41.48% IUA had normal endometrial ultrasonography.There were significant differences in transvaginal sonography among different IUA group (P<0.001).However,with the increase of the degree of adhesion,the proportion of ultrasound confirmed adhesion was not increased.In 444 I~III cases,the endometrial damage of most cases were in the central cavity,the rate was 45.05%.There was a statistically significant difference among different groups (P<0.001).The right site of intrauterine adhesions was significantly higher than the proportion of left.Conclusion:To avoid the formation of IUA,infectious diseases should be treated aggressively and traumatic uterine cavity operation should be reduced.The sensitivity of two-dimensional ultrasound is low,Hysteroscopy is the gold standard for the diagnosis of IUA.