本文選題：腹腔鏡 + 宮腔粘連切除術(shù)　； 參考：《青島大學(xué)》2014年碩士論文

【摘要】：目的探討宮腹腔鏡聯(lián)合治療中重度宮腔粘連臨床療效。 方法選擇2012年1月～2013年10月于我院就診、有生育要求經(jīng)宮腔鏡檢查確診為中重度宮腔粘連62例,其中中度23例,重度39例。所有患者均在腹腔鏡下行宮腔鏡手術(shù)。膨?qū)m后針狀電極劃開宮頸及宮腔粘連并打開宮腔,環(huán)狀電極切取粘連組織,術(shù)畢宮腔內(nèi)注入透明質(zhì)酸鈉后宮腔置Foley導(dǎo)尿管注水球囊壓迫,聯(lián)合雌孕激素人工周期治療3月,合并盆腔病變者同時行腹腔鏡手術(shù)治療,分別于術(shù)后1個月,3個月及6個月復(fù)查隨訪其月經(jīng)恢復(fù)情況及宮腔形態(tài)恢復(fù)情況,對宮腔粘連復(fù)發(fā)者行二次粘連分離術(shù)。隨訪其月經(jīng)及妊娠情況。 結(jié)果62例術(shù)中同時合并盆腔病變者22例(35.48%),其中盆腔粘連8例(12.90%),輸卵管積水系膜囊腫5例(8.06%),盆腔子宮內(nèi)膜異位4例(6.45%),卵巢囊腫2例(3.23%),多囊卵巢3例(4.84%),分別給予相應(yīng)處理。62例手術(shù)前后子宮內(nèi)膜厚度變化比較差異有統(tǒng)計學(xué)意義(F=34.73,P0.05)。62例手術(shù)前后經(jīng)期天數(shù)及月經(jīng)量變化比較差異有統(tǒng)計學(xué)意義(F=38.92,46.53,均P0.05)。術(shù)后1、3、6個月隨訪,23例中度粘連患者宮腔形態(tài)恢復(fù)正常；39例重度粘連者中34例宮腔形態(tài)恢復(fù)正常,3例轉(zhuǎn)為輕度粘連,2例轉(zhuǎn)為中度粘連,給予再次手術(shù)。術(shù)后宮腔再粘連發(fā)生率為8.06%(5/62)。發(fā)生并發(fā)癥1例,已治愈。目前已有8人獲得正常妊娠。 結(jié)論宮腹腔鏡聯(lián)合治療中重度粘連可明顯改善子宮內(nèi)膜厚度,促使宮腔恢復(fù)正常形態(tài),同時對盆腔病變予以相應(yīng)處理,對于改善月經(jīng)、提高正常妊娠率有較大的臨床價值。
[Abstract]:Objective to investigate the clinical effect of hysteroscopy combined with laparoscopy in the treatment of moderate and severe intrauterine adhesions. Methods from January 2012 to October 2013, 62 patients with moderate or severe intrauterine adhesions were diagnosed by hysteroscopy, including 23 moderate cases and 39 severe cases. All patients underwent laparoscopic hysteroscopy. After uterine expansion, the needle electrode opened the cervical and uterine adhesions and opened the uterine cavity. The adhesive tissue was removed by ring electrode. After intrauterine injection of sodium hyaluronate, the Foley catheter was inserted into the uterine cavity for balloon compression, and the artificial cycle of estrogen and progesterone was used for 3 months. The patients with pelvic lesions were treated by laparoscopic surgery at the same time. The menstrual recovery and uterine cavity morphology were followed up at 1 month, 3 months and 6 months after operation, respectively, and secondary adhesion separation was performed in the patients with recurrent intrauterine adhesions. Their menstruation and pregnancy were followed up. Results in 62 cases, 22 cases were complicated with pelvic lesions simultaneously, including 8 cases of pelvic adhesions, 5 cases of hydrosalpinx Mesangial cysts, 5 cases of hydronephrosis, 6.45% of pelvic endometriosis, 2 cases of ovarian cysts, 3 cases of polycystic ovary and 4.84% of polycystic ovary, respectively. There were significant differences in endometrial thickness before and after operation in 62 cases (P < 0.05). There were significant differences in the days of menstrual period and menstrual volume before and after operation in 62 cases (P < 0.05). Among 39 cases with severe adhesions, 34 cases had normal uterine cavity morphology, 3 cases turned to mild adhesion and 2 cases to moderate adhesion. The incidence of postoperative intrauterine re-adhesion was 8. 06%-62%. Complications occurred in 1 case and were cured. At present, 8 people have received normal pregnancy. Conclusion the combination of hysteroscopy and laparoscopy can obviously improve the thickness of endometrium and promote the recovery of uterine cavity to normal shape. At the same time, it is of great clinical value to improve menstruation and increase the rate of normal pregnancy.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713.4

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