目的 探讨宫腔镜联合腹部超声监护识别和处理少见宫腔镜图像的中、重度宫腔粘连(intrauterine adhesion,IUA)的临床疗效。方法 2012年3月~2016年3月我们在腹部超声监护下宫腔镜手术处理241例中、重度IUA,其中12例宫腔镜图像较为少见,7例重度IUA粘连组织较为致密且封闭部分宫腔,采用电刀或冷刀分离/切除粘连组织后见正常宫腔底部,5例中度IUA粘连组织呈膜状且存在数量不等的孔隙,采用宫腔检查镜镜体喙部钝性分离。对比宫腔镜手术前后患者宫腔形态的恢复情况以及月经量的改善情况。结果 手术均顺利完成,无宫腔镜手术并发症发生,宫腔镜手术时间(20±3) min,均恢复正常宫腔形态。IUA美国生育协会(The American Fertility Society,AFS)评分中位数从术前10分(5~12分)下降至术后2分(0~5分)(Z=-3. 095,P=0. 002);月经量月经失血图(pictorial blood loss assessment chart,PBAC)评分中位数从术前8. 5分(0~65分)增加至术后60. 5分(24~86分)(Z=-3. 061,P=0. 002)。结论 宫腔镜联合腹部超声监护能够准确判断宫腔粘连的程度和部位,在宫腔粘连的诊治中有一定的价值,值得临床推广应用。
Objective To discuss hysteroscopy combined with abdominal ultrasonography for the treatment of moderate or severe intrauterine adhesion(IUA)with rare hysteroscopic images.Methods A total of 12 cases of moderate or severe IUA with rare hysteroscopic images treated by hysteroscopic surgery combined with abdominal ultrasound monitoring from March 2012 to March 2016 were analyzed retrospectively.The IUA tissues of 7 cases of severe IUA were relatively dense leading to occlusion of part of uterine cavity.The top of normal uterine cavity could be seen after the adhesion tissue separated or excised by needle electrode or annular electrode.The adhesion tissue in 5 cases of moderate IUA were filmy and varied in amounts of pores,which were bluntly dissected by the hysteroscope front-end.The recovery of uterine cavity morphology and improvement of menstrual amount between preoperation and post-operation were compared.Results The operations were successfully completed,without hysteroscopy related complications.The hysteroscopic operation time was(20±3)min.The uterine cavity morphology was restored to completely or roughly normal in all the cases.The American Fertility Society(AFS)scores decreased from 10(5-12)points preoperatively to 2(0-5)points after operation(Z=-3.095,P=0.002).The pictorial blood loss assessment chart(PBAC)scores of menstrual volume increased from 8.5(0-65)points preoperatively to 60.5(24-86)points after operation(Z=-3.061,P=0.002).Conclusions Hysteroscopy combined with abdominal ultrasonography can accurately judge the degree and location of IUA.It has certain value in the diagnosis and treatment of IUA,which is worthy of clinical application.
Chinese Journal of Minimally Invasive Surgery
Transcervical resection of adhesions
Abdominal ultrasound monitoring