改良式宫腔粘连分离术在薄型子宫内膜中的应用价值

Application value of modified hysteroscopic adhesiolysis in the treatment of thin endometrium

  • 摘要:
    目的 探讨有效治疗薄型子宫内膜(TE)及复原子宫生殖功能的方法。
    方法 回顾性分析48例TE患者改良式宫腔粘连分离术前后经期天数、月经量的月经失血评估表(PBAC)评分及超声指标。
    结果 48例患者术后经期平均天数为(5.60±1.40) d, 长于术前的(4.30±1.20) d, 差异有统计学意义(P < 0.05); 术后月经量PBAC评分为(55.60±6.20)分, 高于术前的(21.40±5.60)分, 差异有统计学意义(P < 0.05); 手术前后双侧子宫动脉阻力指数(RI)均值和脉冲指数(PI)均值的差异无统计学意义(P>0.05); 术后子宫内膜厚度为(9.10±1.10) mm, 子宫内膜容积为(4.68±0.81) cm3, 大于术前的(4.30±1.20) mm和(3.21±0.31) cm3, 差异有统计学意义(P < 0.05); 术后子宫内膜的RI值为(0.51±0.13), PI值为(0.77±0.26), 低于术前的(0.59±0.07)和(0.91±0.18), 差异有统计学意义(P < 0.05)。48例患者妊娠率为60.4%。子宫内膜容积及子宫内膜厚度与妊娠呈正相关(P < 0.05), 子宫内膜RI值和PI值与妊娠呈负相关(P < 0.05)。
    结论 改电流切割为“冷针”物理机械分离瘢痕粘连组织, 可有效修复宫腔的瘢痕粘连,有利于术后子宫内膜血流重建,改善TE患者的宫腔容受性,复原子宫生殖功能。

     

    Abstract:
    Objective To explore the effective therapeutic methods for thin endometrium (TE) and recovery of reproductive function of uterine.
    Methods Menstrual days, the Pictorial Blood Loss Assessment Chart (PBAC) score for menstrual volume, and ultrasound indicators before and after modified hysteroscopic adhesiolysis in 48 patients with TE were retrospectively analyzed.
    Results The average postoperative menstrual period of 48 patients was (5.60±1.40) days, which was significantly longer than (4.30±1.20) days before operation (P < 0.05); the postoperative PBAC score for menstrual volume was (55.60±6.20) points, which was significantly higher than (21.40±5.60) points before operation (P < 0.05); there were no significant differences in the mean resistance index (RI) and pulse index (PI) of bilateral uterine arteries before and after surgery (P>0.05); the postoperative endometrial thickness and the endometrial volume were (9.10±1.10) mm and (4.68±0.81) cm3, which were significantly higher than (4.30±1.20) mm and (3.21±0.31) cm3 before operation (P < 0.05); the postoperative RI value and PI value of the endometrium were (0.51±0.13) and (0.77±0.26), which were significantly lower than (0.59±0.07) and (0.91±0.18) before operation (P < 0.05). The pregnancy rate of 48 patients was 60.4%. The volume and thickness of the endometrium were positively significantly correlated with pregnancy (P < 0.05), while the RI and PI values of the endometrium were negatively significantly correlated with pregnancy (P < 0.05).
    Conclusion Changing electric current cutting to "cold needle" physical and mechanical separation of scar adhesions can effectively repair scar adhesions in the uterine cavity, facilitate postoperative reconstruction of endometrial blood flow, improve uterine receptivity of TE patients, and restore uterine reproductive function.

     

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