本文選題：宮腔鏡　切入點(diǎn)：重度宮腔粘連　出處：《鄭州大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：宮腔粘連(intrauterine adhesions, IUA)是指子宮內(nèi)膜在受到創(chuàng)傷后出現(xiàn)子宮內(nèi)膜纖維化并形成粘連帶,導(dǎo)致宮腔部分或全部閉鎖。臨床表現(xiàn)為月經(jīng)異常(可為經(jīng)量減少或繼發(fā)性閉經(jīng)等),周期性下腹痛,繼發(fā)不孕及異常妊娠(包括復(fù)發(fā)性流產(chǎn),胎死宮內(nèi)及胎盤異常)等。按宮腔鏡檢查所見宮腔粘連的面積及程度可分為輕度,中度及重度粘連,輕、中度宮腔粘連預(yù)后多較好,重度宮腔粘連預(yù)后最差。目前多采用宮腔鏡下宮腔粘連分離術(shù),也是宮腔粘連的標(biāo)準(zhǔn)治療方法。但是重度宮腔粘連分離術(shù)后妊娠率低、再粘連率高,給患者及臨床醫(yī)生帶來很大的困擾,而如何預(yù)防再粘連、提高術(shù)后妊娠率也一直是人們研究的熱點(diǎn)和難點(diǎn)。本研究比較了重度宮腔粘連宮腔鏡分離術(shù)后先放置球囊3天后改為宮內(nèi)節(jié)育器的患者與單純放置宮內(nèi)節(jié)育器患者的月經(jīng)改善率、術(shù)后妊娠率及再粘連率,以尋求一種更好的預(yù)防宮腔粘連術(shù)后復(fù)發(fā)的方法。 材料與方法 1研究對(duì)象 選擇于2009年6月至2010年12月之間在鄭州大學(xué)第三附屬醫(yī)院婦科內(nèi)鏡中心行宮腔鏡下重度宮腔粘連分離術(shù)的120例患者為研究對(duì)象,年齡(31.4±4.6)歲(22-43歲),病程2個(gè)月-4年。 所有患者術(shù)前檢查重要臟器均無嚴(yán)重合并癥,內(nèi)分泌檢查正常。而對(duì)于有妊娠要求的患者還應(yīng)符合以下要求：1)排卵正常(應(yīng)用B超監(jiān)測)2)配偶的精液常規(guī)檢查正常。3)不合并導(dǎo)致不孕的其他疾病。診斷按March分類標(biāo)準(zhǔn)：輕度粘連：粘連范圍小于宮腔的1/4,僅有菲薄或膜性粘連,輸卵管的開口及宮底上段有很輕微的病變或無病變；中度粘連：粘連累及1/4至3/4的宮腔,僅有粘連,而無宮壁之間的粘著,輸卵管的開口及宮腔上段僅有部分閉鎖；重度粘連：粘連范圍超過宮腔的3/4,宮壁之間相互粘著或有致密肥厚的粘連帶形成,輸卵管的開口及宮底上段閉鎖。 2手術(shù)方法及術(shù)后處理 所有患者均行宮腔鏡下宮腔粘連電切術(shù),手術(shù)在經(jīng)腹B超監(jiān)護(hù)下進(jìn)行。術(shù)后宮腔注射玻璃酸鈉,放置充水球囊或?qū)m內(nèi)節(jié)育器,雌孕激素人工周期治療2個(gè)周期。 3分組及術(shù)后隨訪情況 按照術(shù)后預(yù)防再粘連方法的不同將患者分為放環(huán)組及水囊+放環(huán)組：放環(huán)組61例,手術(shù)后向?qū)m腔內(nèi)注射玻璃酸鈉針25mmg并放置金屬圓環(huán)1枚；水囊+放環(huán)組59例,手術(shù)后向?qū)m腔內(nèi)注射玻璃酸鈉25mg同時(shí)放置Foley氏導(dǎo)尿管,B超監(jiān)護(hù)下根據(jù)宮腔大小向?qū)蚬芮蚰覂?nèi)灌注生理鹽水3～5ml,3天后取出Foley氏導(dǎo)尿管并于宮腔內(nèi)放置金屬圓環(huán)1枚。 術(shù)后2個(gè)療程人工周期結(jié)束后行宮腔鏡檢查了解患者宮腔形態(tài)并取出宮內(nèi)節(jié)育器,之后第3、6個(gè)月及以后每6個(gè)月隨訪一次,了解患者月經(jīng)量及妊娠情況。隨訪時(shí)間6個(gè)月至24個(gè)月,中位隨訪時(shí)間16個(gè)月。 4統(tǒng)計(jì)學(xué)處理 應(yīng)用SPSS18.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理,連續(xù)型變量采用t檢驗(yàn),率的比較采用χ2檢驗(yàn),檢驗(yàn)水準(zhǔn)α=0.05。 結(jié)果 球囊+放環(huán)組術(shù)后再粘連率16.9%,低于放環(huán)組32.8%(P0.05)。球囊+放環(huán)組與放環(huán)組月經(jīng)改善率分別為96.6%,85.2%,前者高于后者,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)于有妊娠要求的患者,球囊+放環(huán)組與放環(huán)組術(shù)后妊娠率分別為：38.5%,33.9%,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 重度宮腔粘連宮腔鏡電切分離術(shù)后充水球囊聯(lián)合放環(huán)能更有效預(yù)防宮腔再粘連,更好的改善月經(jīng),但不能提高術(shù)后妊娠率。
[Abstract]:Intrauterine adhesions (intrauterine adhesions IUA) refers to the endometrium in trauma after endometrial fibrosis and the formation of adhesions, leading to intrauterine atresia. All or part of the clinical manifestations of abnormal menstruation (as by the amount of reduction or secondary amenorrhea etc.), periodic abdominal pain, infertility and abnormal pregnancy (including recurrent spontaneous abortion, fetal death and abnormal placenta). By hysteroscopy see the area and the degree of intrauterine adhesions can be divided into mild, moderate and severe adhesion, light, moderate intrauterine adhesions and the prognosis is much better, severe intrauterine adhesions after pretreatment is the worst. The current use of hysteroscopic intrauterine adhesions. Is the standard treatment for intrauterine adhesions. But severe intrauterine adhesions after low pregnancy rate and high recurrent rate, bring great distress to the patients and clinicians, and how to prevent re adhesion, improve the postoperative pregnancy rate has also been a person The hot and difficult research. This study compares severe hysteroscopic after exclusion of 3 days to first balloon placement of IUD patients with simple IUD in patients with menstrual improvement rate, postoperative pregnancy rate and recurrent rate, to seek a better prevention of intrauterine adhesions the postoperative recurrence.
Materials and methods
1 research objects
From June 2009 to December 2010, 120 patients with severe intrauterine adhesion separation under hysteroscopy were enrolled in the gynecology center of the Third Affiliated Hospital of Zhengzhou University. The age of the patients was (31.4 + 4.6) years (22-43 years), and the duration of the disease was 2 months -4 years.
All the patients had no serious complications of important organs, endocrine examination was normal. But for pregnancy patients should meet the following requirements: 1) normal ovulation (B-ultrasound monitoring) 2) the spouse of the normal semen.3) not associated with other diseases causing infertility diagnosis. According to March classification: mild adhesion: adhesion of the uterine cavity range is less than 1/4, only a thin or membranous adhesions, tubal opening and upper fundus have very slight lesions or no lesions; moderate adhesions: intrauterine adhesions involving 1/4 and 3/4 only adhesion, and no adhesion between the uterine wall, tubal opening and palace only the upper part of cavity atresia; severe adhesion of uterine cavity adhesion: range of more than 3/4, the formation of adhesions between the uterus wall with dense adhesion or hypertrophy, tubal opening and fundus upper atresia.
2 methods of operation and postoperative treatment
All patients underwent hysteroscopic intrauterine adhesion electrocision in abdominal surgery under B-ultrasound monitoring. Postoperative intrauterine injection of sodium hyaluronate, water filled balloon or placed IUD, estrogen and progesterone artificial cycle for 2 cycles.
3 groups and postoperative follow-up
鎸夌収鏈悗棰勯槻鍐嶇矘榪炴柟娉曠殑涓嶅悓灝嗘?zhèn)ｈ�呭垎涓烘斁鐜粍鍙?qiáng)姘村洠?

本文編號(hào)：1616241