论文部分内容阅读
目的:探讨宫腔镜下子宫中隔切除(transcervical resection of septum,TCRS)术后预防宫腔粘连形成及改善妊娠结局的最佳治疗方案。方法:TCRS术后患者116例随机分为4组:A组(n=30),术后行人工周期;B组(n=31),术后宫腔放置宫内节育器(IUD);C组(n=27),术后放置IUD+行人工周期;D组(n=28),术后不采取任何干预措施。术后3个月再次行宫腔镜检查,观察宫腔是否发生粘连及粘连分布,随访至术后24个月,记录月经恢复情况及妊娠结局。结果:A组排除9例(6例失访,3例漏服药物),B组排除6例(4例失访,2例IUD脱落),C组排除2例(1例失访,1例IUD下移),D组排除5例(均为失访)。4组术后3个月宫腔粘连发生率依次为:14.2%(1/7)、37.5%(3/8)、22.2%(2/9)、9.1%(1/11);随访至术后24个月,妊娠率分别为:33.3%(7/21)、32.0%(8/25)、36.0%(9/25)、47.8%(11/23);流产率分别为:4.8%(1/21)、12.0%(3/25)、8.0%(2/25)、4.3%(1/23),宫腔粘连发生率、妊娠率和流产率组间均无统计学差异(P>0.05)。结论:TCRS术后进行人工周期、IUD、IUD+人工周期3种治疗方法对防止宫腔粘连形成及提高妊娠率、改善妊娠结局方面无明显益处,且治疗效果差别不大,术后不必将其作为常规治疗方法。
Objective: To explore the best treatment for hTERT after hysteroscopic transcervical resection of septum (TCRS) to prevent intrauterine adhesions and improve pregnancy outcome. Methods: One hundred and sixty-six patients with TCRS were randomly divided into 4 groups: group A (n = 30), artificial cycle after operation; group B (n = 31), intrauterine IUD insertion (N = 27). The postoperative IUD + artificial cycle was performed. In group D (n = 28), no intervention was taken after surgery. Hysteroscopy was performed again 3 months after operation to observe the distribution of adhesions and adhesions in the uterine cavity. The patients were followed up to 24 months after operation and the recovery of menstruation and pregnancy outcome were recorded. Results: In group A, 9 cases were excluded (6 lost and 3 missed), 6 in group B (4 lost and 2 in lost), 2 in group C IUD down), D group excluded 5 cases (all lost). The incidence of intrauterine adhesions in the 4 groups was 14.2% (1/7), 37.5% (3/8), 22.2% (2/9), 9.1% (1/11) The pregnancy rates at 24 months were 33.3% (7/21), 32.0% (8/25), 36.0% (9/25) and 47.8% (11/23), respectively. The miscarriage rates were 4.8% (1 /21),12.0%(3/25),8.0%(2/25),4.3%(1/23), the incidence of intrauterine adhesions, pregnancy rate and abortion rate were no significant difference (P> 0.05 ). Conclusion: The three kinds of treatment methods of artificial cycle, IUD and IUD + artificial cycle after TCRS have no obvious benefit in preventing the formation of intrauterine adhesions, improving the pregnancy rate and improving the outcome of pregnancy, and the treatment effect is not much different. Routine treatment.