宫腔粘连分离术中应用微型剪的效果评估

doi:10.3969/j.issn.2095-9400.2019.01.012

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摘要目的：比较微型剪和电切环在有生育要求的中重度宫腔粘连患者手术中的应用效果差异。方法：选择2014年9月至2016年12月至浙江省人民医院生殖内分泌科因中重度宫腔粘连拟行宫腔镜下粘连分离术的女性患者82例，分为微型剪分离组（n=39）和电切环分离组（n=43）。在手术当月的月经周期第3天口服雌激素预处理，术后放置宫内节育器防止再度粘连形成。术后1～2个月行2次宫腔探查，宫腔粘连程度采用AFS评分系统进行评价，术后随访1年内的妊娠情况（包括自然妊娠及辅助生殖）。结果：2次宫腔探查结果提示，2组患者宫腔形态的恢复程度差异无统计学意义（P＞0.05）；微型剪分离组的月经改善情况明显好于电切环分离组，微型剪分离组患者手术前后宫腔粘连评分的降低程度高于电切环分离组，差异均有统计学意义（P＜0.05）。术后妊娠随访提示微型剪分离组患者术后妊娠率（43.6%）高于电切环分离组（37.2%）。结论：宫腔镜下宫腔粘连分离手术中，采用微型剪或者电切环均可在一定程度上改善宫腔形态和月经情况。在有生育要求的女性中，采用微型剪分离宫腔粘连可能更具优势。

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	傅晓华
	姬萌霞
	舒静

关键词 ：宫腔粘连, 微型剪, 电切环, 宫腔镜

Abstract：Objective: To compare the effectiveness of micro-scissor with electric-loop in hysteroscopic adhesiolysis for moderate- to severe-intrauterine adhesion women with fertility intention. Methods: In this study, 82 women from Zhejiang Provincial People’s Hospital during September 2014 to December 2016 underwent hysteroscopic division procedure were allocated to micro-scissor group (n=39) and electric-loop group (n=43). Oral estrogen was administered to promote endometrial regeneration at operation period mense day 3, and an IUD was inserted after operation to prevent adhesion reformation. A second look hysteroscopic was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society Classification system (AFS). Pregnant outcome, including natural and assisted reproductive pregnancy, was also followed up for one year after operation. Results: At the second look, there was no significant difference in the post-operative recovery of uterine shape between two groups. However, the recovery of menstruation was significantly better in the micro-scissor group than the electric loop group. In addition, the pregnancy rate in the micro-scissor group was 43.6%, which was also higher than 37.2% in the electric loop group. Conclusion: Using micro-scissor or electric-loop in hysteroscopic adhesiolysis could improve uterine morphology and menstrual pattern to a certain extent. Treatment with micro-scissor may be a good try in women with fertility intention.

Key words： intrauterine adhesions micro-scissor electric-loop hysteroscopes

基金资助:浙江省医药卫生科技计划项目（2013KYA013）；浙江省医药卫生临床研究项目（2018ZD012）。

通讯作者: 舒静，主任医师，Email：fxh9210@163.com。

作者简介: 傅晓华（1977-），女，山东临沂人，副主任医师，博士。

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https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2019.01.012 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I1/52

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