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目的:评估宫腔镜在诊断和治疗宫腔粘连中的应用价值。方法:回顾性分析经门诊宫腔镜检查确诊为宫腔粘连的920例患者的病例资料。其诊治流程为:宫腔镜检查轻度粘连即时行机械分离术,术后给予人工周期治疗;中-重度粘连收入住院行宫腔镜下粘连分离术,术后3~7 d及1个、2个、3个月经周期后宫腔镜复查,同时辅助防粘连剂、球囊、宫内节育器和激素等综合治疗。结果:920例患者在门诊实施宫腔镜检查时均能清楚显示粘连部位、性状,且能对其做出准确分类以指导下一步治疗。其中702例轻度患者在门诊即诊即治,术后宫腔恢复率100%;218例中-重度患者收入住院行宫腔粘连分离术(TCRA),术后3个月经周期复查,188例(86.2%)宫腔恢复良好,165例(75.7%)月经改善;随访8~46个月,受孕97例(44.5%),活产47例(48.5%)。结论:宫腔镜检查是确诊宫腔粘连及对其进行分类的金标准;轻度粘连患者在门诊宫腔镜手术室即可诊治,无需住院;有生育要求的患者术中腹腔镜监测优于超声监测;术后3~7 d及1、2、3个月经周期后复查宫腔镜对预防再粘连起到积极作用。
Objective: To evaluate the value of hysteroscopy in the diagnosis and treatment of intrauterine adhesions. Methods: A retrospective analysis of hysteroscopy diagnosed as intrauterine adhesions in 920 cases of patient data. The diagnosis and treatment of hysteroscopy: mild hysteroscopy with mechanical adhesions immediately after surgery, and artificial cycle treatment after surgery; hysteroscopic adhesion separation in hospitalized patients with moderate-severe adhesions, 3 to 7 days and 1, 2 A, 3 menstrual cycle after hysteroscopy review, while supporting the anti-adhesive agent, balloon, intrauterine device and hormones and other comprehensive treatment. Results: 920 patients in hysteroscopy at the clinic can clearly show the adhesion sites, traits, and can make an accurate classification to guide the next step of treatment. Among them, 702 mild patients were diagnosed and treated in the outpatient department and the postoperative uterine cavity recovery rate was 100%. Among 218 patients with moderate-severe disease, admission to hospital was performed intrauterine adhesions (TCRA), 3 menstrual cycles were reviewed, 188 86.2%) uterine cavity recovered well, and 165 cases (75.7%) had menstrual improvement. During the follow-up of 8 to 46 months, 97 cases (44.5%) and 47 live births (48.5%) were conceived. Conclusion: Hysteroscopy is the gold standard for the diagnosis of intrauterine adhesions and the classification of them. Mild adhesion patients can be diagnosed and treated in the hysteroscopic surgery room without hospitalization. Laparoscopy monitoring in patients with reproductive requirements is superior to Ultrasound monitoring; 3 ~ 7 d after surgery and 1, 2, 3 menstrual cycle after hysteroscopy to prevent re-adhesion plays a positive role.