宫腔镜诊论文：宫腔镜诊治宫腔粘连289例分析

宫腔镜诊论文：宫腔镜诊治宫腔粘连289例分析 宫腔镜诊论文:宫腔镜诊治宫腔粘连289例分析 [摘要] 目的 探讨宫腔镜治疗宫腔粘连的临床效果。方 法 宫腔镜分离子宫腔粘连289例,术后给予抗生素、人工周 期、iud 留置治疗。结果 除4例经3次手术外，34例经2 次手术外，其余均一次成功,总成功率86.9%。(251/289)。 结论 宫腔镜诊断宫腔粘连直观、准确、简便，并可同时完 成简单的镜下手术，效果佳，费用低，是诊断和治疗宫腔粘 连的可靠。 [关键词] 宫腔镜; 检查; 宫腔粘连 clinical value of hysterocopy in diagnosing and treating intrauterine adhesion [abstract] objective to investigate the clinical effect of hysteroscope in the treatment of uterin cavity adhesion. methods electric knife of hysteroscope was used to cut adhesion , which was monitored by b-ultrasound. antibotics , artificial hormonal cycle treatment and iud in uterin cavity were used after operation. results after hysteroscopy treatment , 289patients were detached completely in once operation and 34 patients were operated for twice time, 4 patients were operated for third time the total successful rate of operation were 86.9%.(251/289).conclusion hysteroscopy is an effective method to diagnosing and treating intrauterine adhesion. [keywords]hysteroscopy; diagnosis; intrauterine adhesion 宫腔粘连(intrauterine adhesion , iua)的主要临床 现为闭经、 月经过少、周期性下腹痛、 肛门坠痛等，以 及生育障碍如不孕、流产等。以往诊断主要根据宫腔手术史 和临床表现,采用盲目的宫腔探查及扩宫术,导致一些病例 诊断不明确,粘连松解不充分。宫腔镜是近代妇产科新兴的 微创内镜学技术,由于具有直观、 清晰、 安全、 可靠的特 点,能明确粘连的范围及性质,并可在直视下分离,避免了盲 目分离导致的不完全性损伤。目前公认宫腔镜为诊治子宫粘 连的首选方法[1]。我们分析了宫腔镜检查治疗的宫腔粘连 497例，现作如下报告。 1 临床资料与方法 1.1 一般资料 以2004年12月-2009年12月在我院行宫腔镜检查治疗 的宫腔粘连289例为研究对象，平均年龄为28.5岁，其中 86.7,的患者以月经过少或闭经就诊。全部病例体格检查无 异常,基础体温和内分泌检查提示卵巢功能正常。 1.2 诊断和分型的 月经稀少指经期缩短不足两天和估计的经量少于30毫升。继发闭经的诊断以文献[2]为标准。宫腔粘连按宫腔粘连内镜学分型标准[3]:轻度，累及宫腔小于 尽管宫腔镜诊断宫腔粘连直观、准确、简便，但它引起的并发症仍应引起高度的重视。国外报道,在宫腔镜手术并发症中, 宫腔粘连切除术的并发症发生率为2.5 %-4.15 % [11、12] ;子宫穿孔发生率为0.145 %,4.100 %[13、14]，且多发于子宫角、子宫底、子宫峡部等。所以粘连严重、范围广的患者，充盈膀胱后在b超监测下分离显得尤为必要。 综上所述宫腔镜检查术简单易行,操作无需特殊麻醉,具有良好的可接受性和高度的准确性,可以充分了解宫腔粘连的具体情况并及时予以治疗，值得推广。 参考文献 [1] 黎培毅,夏恩兰.整理全国妇产科内镜应用学术研讨会纪要[j].中华妇产科杂志,1997,32(5):265. [2] 乐杰,主编. 妇产科学[m]. 第6版. 北京: 人民卫生出版社,2004.45:338. [3] 夏恩兰,主编. 妇科内镜学[m]. 第1 版.北京:人民卫生出版社,2001:107. [4] pace s, stentella p, catania r, et al. endoscop ic treatment of intrauterine adhesions. clin exp obstet gynecol, 2003, 30 (1) : 26. [5] de bloks ,wamsteker k. hysteroscopic surgery :possibility ,limitations and future. reprod med review ,1995 ,4(4):101. [6] pace s ,stentella p ,catania r ,et al . endoscopic treatment of intrauterine adhesions. clin exp obstet gynecol ,2003 ,30(1) :26. [7] wang y, han m, li e , et al . the value of hysteroscopy in the diagnosis of infertility and habitual abortion[j]. chin med sci j,1992, 7 (4):226. [8] 关铮,主编. 现代宫腔镜诊断治疗学[m]. 北京: 人民军医出版社,2001:113. [9] merviel p , mergui jl , sananes s , et al . role of hysteroscopy in the diagnosis and treatment of infertility. presse med,2000,29(23):1302. [10] guida m, acunzo g, di spiezio sardo a, et al. effectiveness of autocrosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. hum rep rod, 2004, 19 (6): 1461. [11] bukulmez o ,yarali h ,gurgan t. total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopicsynechialysis. hum reprod, 1999,14(6):1960. [12] frank wj , corla bv , karin vu , et al. complications of hysteroscopy : a prospective ,multicenter study. obstet gynecol,2000,96(2):267. [13] leuschner h , riedel hh , anders m. hysteroscopic survey from 1994 to 1996 in the eastern part of germany[j]. j am assoc gynecol laparosc,1997,4(4suppl):s28. [14] castaing n ,darai e ,chuong t ,et al. mechanical and metabolic complications of hysteroscopic surgery : report of a retrospective study of 352 procedures. contracept fertil sex ,1999,27(3):210.