宫腔粘连患者宫腔镜治疗的生殖预后分析

目的探讨宫腔镜行宫腔粘连分离术后患者的妊娠结局及其相关影响因素。方法收集近年收治的，因宫腔粘连所致不孕，行宫腔镜下粘连分离术68例患者的临床资料，随访患者术后的妊娠结局，选择宫腔粘连性质、范围、程度、术后月经恢复、宫内节育器、人工周期及术后年限等7个因素进行妊娠结局的相关性分析。结果术后妊娠率为66.2%（45/68），难免流产3例5例次，输卵管妊娠1例，获得存活胎儿妊娠41例42例次，获得存活胎儿的有效妊娠率为61.8%（42/68）。42例次有效妊娠中，1例孕34周早产，5例胎位异常，1例妊娠合并肝内胆汁淤积症，1例帆状胎盘伴胎盘粘连，3例先兆流产同时合并胎盘粘连2例，剖宫产率为73.8%（31/42）。统计学分析显示，获得存活胎儿的概率与术后月经是否恢复正常、术后年限直接相关（均P＜0.05）。结论宫腔粘连所致不孕患者行宫腔镜下粘连分离术后应着重恢复正常月经，并积极争取术后1年内的最佳时间妊娠，以获得好的妊娠结局，术后妊娠者应视为高危人群。

Reproductive outcomes after hysteroscopic resection of intrauterine adhesions

Objective To evaluate reproductive outcomes after hysteroscopic resection of intrauterine adhesions. Meth-ods The reproductive outcomes of 68 patients with intrauterine adhesions who underwent hysteroscopic adhesiolysis were ret-rospectively analyzed. The factors related to pregnancy outcome were analyzed, including the type, area, degree of adhesion, postoperative resumption of menstruation, IUD usage, artificial menstrual cycle and fol ow- up time. Results Forty five preg-nancies were achieved in 68 patients （66.2%）, including 42 childbirths, 5 spontaneous abortions and 1 tubal ectopic pregnancy. Forty two viable infants were delivered in 41 cases （61.8%）, including 1 case of premature delivery in 34 pregnancy weeks, 5 abnormal fetal position, 1 intrahepatic cholestasis, 3 threatened abortion accompanied with placenta adhesions;and the rate of cesarean section is 73.8%（31/42）. The pregnancy outcome was associated with resumption of menstruation and postoperative time（P〈0.05）. Conclusion The results suggest that resumption of menstruation and pregnancy within 1 year after hysteroscopic adhesiolysis are important to acquire favorable pregnancy outcome for patients with intrauterine adhesions.