[1]汤一群,段华*,汪沙,等.中重度宫腔粘连术后妊娠率及其影响因素分析[J].中国计划生育和妇产科,2017,(1):37-41.
　TANG Yi-qun,DUAN Hua*,WANG Sha,et al.Analysis of pregnancy rate and its influencing factors after surgeries for moderate to severe intrauterine adhesions[J].Chinese Journal of Family Planning & Gynecotokology,2017,(1):37-41.
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中重度宫腔粘连术后妊娠率及其影响因素分析
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年1期
页码:
37-41
栏目:
论著与临床
出版日期:
2017-01-25

文章信息/Info

Title:
Analysis of pregnancy rate and its influencing factors after surgeries for moderate to severe intrauterine adhesions
作者:
汤一群; 段华*; 汪沙; 甘露; 徐倩
首都医科大学附属北京妇产医院妇科微创中心
Author(s):
TANG Yi-qun;  DUAN Hua*;  WANG Sha;  GAN Lu; XU Qian
Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, P.R.China
关键词:
宫腔粘连; 妊娠率; 影响因素
Keywords:
intrauterine adhesions;  pregnancy rate;  influencing factor
摘要:
目的探讨中重度宫腔粘连(intrauterine adhesions, IUA)患者行宫腔镜宫腔粘连分离术（transcervical resection of uterine adhesions，TCRA）后妊娠率及相关影响因素。方法选择2013年3月至2015年4月首都医科大学附属北京妇产医院有生育要求的中重度IUA患者（IUA评分≥5分）162例，随访术后妊娠情况，对可能影响妊娠率的因素进行分析。结果 ①TCRA术后平均随访（212±57）个月，患者术后月经改善率为821%（133/162）；957 %（155/162）的患者术后IUA评分较术前降低；术后妊娠率为432 %（70/162），其中，中度（IUA评分5~8分）490 %（53/108），重度（IUA评分9~12分）314 %（17/54）；活产率为585%（41/70），其中，中度为585 %（31/53），重度为588 %(10/17)，41例活产中自然分娩12例，剖宫产29例（707 %）；其中3例胎盘残留、2例前置胎盘。② 影响妊娠率的因素：残留内膜面积是影响术后妊娠率的独立因素（OR=0141，95 % CI：0069~0289；P<0001）；二探评分、粘连程度、术后月经量与妊娠率显著相关（P<005）；年龄、妊娠相关刮宫次数、防粘连措施与妊娠率无关（P＞005）。③ 妊娠时限：885 %的妊娠患者均在术后1年内妊娠（62/70），累计妊娠率在术后18月后无增长。结论中重度IUA术后妊娠率较低，残留内膜面积是影响术后妊娠率的关键因素，TCRA术中应规范操作，强调对残留内膜的保护。
Abstract:
ObjectiveTo investigate the pregnancy rate and its influencing factors after transcervical resection of uterine adhesions (TCRA) in patients with moderate to severe intrauterine adhesions(IUA).Methods162 patients with moderate to severe intrauterine adhesions who underwent TCRA in Beijing Obstetrics and Gynecology Hospital affiliated of Capital Medical University from March 2013 to April 2015 were chosen, followed up pregnancy outcomes after the surgery. Then evaluated the possible factors influencing pregnancy rates.Results①The average follow-up time after TCRA was（212±57）months, 821%(133/162) patients had an improvement in menstrual blood volume and 957%(155/162) of the patients had lower IUA scores postoperatively; The overall pregnancy rate was 432%(70/162),with 490% (53/108) and 314%(17/54) in those with moderate and severe adhesions respectively. The overall live birth rate was 585% (41/70), 585%(31/53) in moderate cases while 588%(10/17) in severe cases; Of 41 cases of live birth,29 patients(707%) underwent cesarean section, placenta previa developed in two patients and three had placenta remnants.② The factors affecting pregnancy rate:Residual endometrial area was the independent factor influencing postoperative pregnancy rate (OR = 0141, 95% CI: 0069-0289; P<0001); the degree of adhesions, IUA score and postoperative menstrual blood volume were statistically significant associated to pregnancy rate(P<005).③The time before pregnancy: 885%(62/70) of patients achieved pregnancy within 1 year after surgery, the cumulative pregnancy rate after 18 months have barely increased.ConclusionThe rate of pregnancy in moderate to severe IUA patients after surgeries is relatively low.Residual endometrial area is a keyfactor in postoperative pregnancy rate. We need to emphasize the standardization of TCRA surgery as well as the protection of residual endometrium.

参考文献/References:

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备注/Memo

备注/Memo:
北京市医院管理局重点医学专业发展项目（ZYLX201406）;首都卫生发展科研专项重点攻关项目（2014-1-2112）；国家科技支撑计划（2014BAI05B03）
更新日期/Last Update: 2017-01-25