發(fā)布時間：2018-05-28 15:08

  本文選題：宮腔粘連 + 宮腔粘連分離術(shù)��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]通過了解我院收治的80例宮腔粘連患者病因,輔助檢查結(jié)果及臨床癥狀、首次宮腔鏡檢查宮腔粘連情況、二探時宮腔形態(tài)恢復(fù)及復(fù)粘率,從而評價宮腔粘連患者行宮腔鏡下宮腔粘連分離術(shù)的有效性,及術(shù)后放置水囊并聯(lián)合雌激素或雌、孕激素人工周期治療后的宮腔形態(tài)恢復(fù)、月經(jīng)改善情況及妊娠率。[方法]對2015年06月至2015年12月昆明醫(yī)科大學(xué)第一附屬醫(yī)院門診及住院部宮腔粘連的80例患者進(jìn)行回顧性分析,患者均采用微型剪刀行宮腔鏡下宮腔粘連分離術(shù),術(shù)畢根據(jù)粘連程度放置水囊數(shù)小時至數(shù)天不等,輕、中度患者術(shù)后予戊酸雌二醇2片/Bid連續(xù)治療21天,后11天加服地屈孕酮1片/Bid,停藥轉(zhuǎn)經(jīng),待下次月經(jīng)干凈后行二次宮腔鏡檢查,同時開始第二周期服藥(方法同前),共三個周期;重度患者術(shù)后亦予以戊酸雌二醇2片/Bid連續(xù)無間斷治療三個周期,于最后10天加服地屈孕酮1片/Bid,重度患者于1月后進(jìn)行二次宮腔探查。二次宮腔鏡檢查方法同第一次手術(shù),如發(fā)現(xiàn)復(fù)粘,同法用微型剪刀分離粘連。術(shù)前術(shù)后均采用美國生育協(xié)會(AFS)標(biāo)準(zhǔn)對宮腔粘連程度進(jìn)行評分,隨訪二探時宮腔形態(tài),二探12個月后月經(jīng)量改善、腹痛緩解、再次妊娠情況。所獲數(shù)據(jù)理采用SPSS 17.0統(tǒng)計學(xué)軟件處理,計數(shù)資料與計量資料分別以百分比(%)、均數(shù)±標(biāo)準(zhǔn)差(x±s)格式表示,計量資料組間均數(shù)比較采用單因素方差分析,計數(shù)資料組間比較采用χ2檢驗,以P0.05表示差異有統(tǒng)計學(xué)意義。[結(jié)果]80例患者依宮腔粘連程度分為輕度粘連24例,中度粘連36例,重度粘連20例。不同宮腔粘連程度的TCRA術(shù)前及術(shù)后AFS評分差異均有統(tǒng)計學(xué)意義(p0.05),AFS評分術(shù)后較術(shù)前明顯下降。二探時總體宮腔形態(tài)恢復(fù)率達(dá)85%(68/80例)。術(shù)前60例出現(xiàn)月經(jīng)改變(經(jīng)量較少+閉經(jīng))IUA患者,總月經(jīng)改善率為90%(54/60例)。宮腔粘連分離術(shù)后患者有效率達(dá)91.3%,26例繼發(fā)性不孕患者,截止隨訪時,再次妊娠的有15例,總?cè)焉锫蔬_(dá)57.7%。[結(jié)論]宮腔鏡下利用微型剪刀的宮腔粘連分離術(shù)是治療宮腔粘連的有效方式,術(shù)后放置水囊并使用雌激素或雌、孕激素人工周期治療可有效避免宮腔再次粘連,增加月經(jīng)量,提高妊娠率。
[Abstract]:[objective] to investigate the etiology, auxiliary examination results and clinical symptoms of 80 cases of intrauterine adhesions in our hospital, the first hysteroscopy to examine the condition of intrauterine adhesions, and the recovery of uterine cavity morphology and the rate of readhesive during the second visit. In order to evaluate the effectiveness of hysteroscopic separation of intrauterine adhesions in patients with intrauterine adhesions, the uterine cavity morphology, menstrual improvement and pregnancy rate after implantation of water sac combined with estrogen or estrogen, progesterone and artificial cycle therapy were evaluated. [methods] from June 2015 to December 2015, 80 patients with intrauterine adhesions in outpatient and inpatient department of the first affiliated Hospital of Kunming Medical University were retrospectively analyzed. At the end of the operation, according to the degree of adhesion, the water sac was placed for several hours to several days. The mild and moderate patients were treated with estradiol valerate 2 / bid continuously for 21 days after the operation. After 11 days, they were given diproprogesterone 1 / Bidder, and stopped the drug transfer. After the next menstruation was clean, the second hysteroscopy was performed, and the second cycle of medication was started. (the same method was used in three cycles, and the severe patients were also treated with estradiol valerate 2 / bid for three consecutive cycles without interruption. On the last 10 days, Diproprogesterone 1 / Bid1 was added, and severe patients underwent second intrauterine exploration after 1 month. The second hysteroscopy is the same as the first operation, if complex adhesion is found, the adhesions are separated with microscissors. The degree of intrauterine adhesions was evaluated by the American Fertility Association (AFS) standard before and after operation. The uterine cavity morphology was followed up 12 months later, the menstrual volume was improved, abdominal pain was alleviated, and pregnancy was repeated. The obtained data were processed by SPSS 17.0 statistical software. The counting data and the measurement data were expressed in the format of percentage and mean 鹵standard deviation respectively. The mean of the measurement data groups was compared by single factor analysis of variance (ANOVA). 蠂 2 test was used to compare the counting data between groups, and the difference was statistically significant with P0.05. [results] according to the degree of intrauterine adhesion, 80 cases were divided into mild adhesion (24 cases), moderate adhesion (36 cases) and severe adhesion (20 cases). There were significant differences in AFS scores before and after TCRA with different degree of intrauterine adhesion. The overall recovery rate of uterine cavity shape was 85%, 68% and 80 cases. There were 60 cases with menorrhagia before operation. The total menorrhagia improvement rate was 90% 54 / 60 cases. The effective rate was 91.3% in 26 cases of secondary infertility. At the end of follow-up, 15 cases were pregnant again, and the total pregnancy rate was 57.7%. [conclusion] the intrauterine adhesion separation with microscissors under hysteroscopy is an effective method for the treatment of intrauterine adhesions. After the implantation of water sac and estrogen or estrogen, progesterone artificial cycle therapy can effectively avoid uterine cavity adhesion again and increase menstrual volume. Increase the pregnancy rate.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R713.4

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