摘要
目的探讨宫腔粘连(IUA s)患者子宫结合带(JZ)损伤程度对术后妊娠结局的影响。方法回顾性分析2011年7月-2014年7月于海军总医院住院行子宫MRI及超声引导下宫腔粘连松解术,术后试孕时间超过6个月,符合入组标准的92例IUAs患者的临床资料。根据MRI子宫JZ是否受损将IUAs分为A组(JZ正常组)、B组(JZ损伤组),2015年8月电话随访所有IUAs患者的妊娠情况,比较两组重度IUAs所占比例、妊娠率、活产率及妊娠丢失率之间的差异。结果A、B组分别有51、41例IUAs,按照1995年欧洲腔镜协会宫腔粘连分类标准,A组轻、中、重度IUAs分别为20、24、7例,B组分别为10、12、19例,B组重度IUAs所占比例明显高于A组(P=0.001)。所有IUAs患者中有46例妊娠,妊娠率为50%(46/92)。其中4例IUAs术后妊娠2次,21例顺利分娩(其一为双胎分娩),抱婴率为42%(21/50),妊娠丢失率为38%(19/50),10例正处于妊娠期。A、B组妊娠人数(妊娠次数)分别为31例(34次)和15例(16次),妊娠率分别为60.8%和36.6%,差异有统计学意义(P=0.021);抱婴率分别为47.1%和31.3%,妊娠丢失率分别为29.4%和56.3%,差异均无统计学意义(P=0.365,P=0.117)。B组中8例JZ完全不清,JZ不可辨认,宫腔镜下为V级IUA,术后无1例怀孕。结论子宫JZ损伤越重,IUA程度可能越重,妊娠率及抱婴率下降,孕期妊娠丢失率增加。JZ损伤程度是评估IUA严重程度及术后妊娠结局的新视角,可作为一项独立指标用以评估IUA严重程度及术后生殖预后,尤其对于重度IUAs,JZ严重损伤者,术后妊娠结局极差。
Objective To investigate the influence of degree of the injury in uterine junctional zone（ JZ） of intrauterine adhesions（IUAs） patients on postoperative pregnancy outcomes by magnetic resonance imaging（MRI）. Methods Design： Retrospective obser vational study. Setting ： Navy General Hospital of PL A, Beijing. The study included ninety-two patients undergoing preoperative pelv ic MRI from June 2011 to June 2014, and they were diagnosed as IUA by hysteroscopy, and hysteroscopic adhesiolysis was conducted under the guidance of abdominal ultrasound. All patients had tried to be pregnant for longer than six months. According to whether uterine junctional zone（ JZ） was injured or not, the patients were divided into two groups： group A（ JZ was normal） and group B（ JZ was partly or completely injured）. All patients were followed up with telephone comunication regarding postoperative pregnancy outcome within two weeks in August 2015. The difference of severity of IUAs and pregnancy outcome was compared. Results There were 51 and 41 IUAs cases in Group A and Group B, respectively. According to European Society of Gynecological Endoscopy（ESGE） classification of IUAs, the number of mild, moderate and severe IUA cases were 20, 24 and 7, respectively, in group A; and 10, 12 and 19, respectively, in group B. The proportion of severe IUA cases was significantly higher in group B than in group A（P=0.001）. Forty-six of 92 IUAs cases had been pregnant, the pregnancy rate was 50%. Among them 4 had conceived twice. Twenty-one IUAs had given live birth（one had given birth to a pair of twins）, and 10 were in pregnancy. The live-birth delivery rate was 42%, and the pregnancy loss rate was 38%. Thirty-one and fifteen IUAs had been pregnant in group A and group B respectively, the pregnancy rate was higher in group A than in group B（60.8% vs 36.6%, P=0.021）. The live-birth delivery rate was higher in group A than in group B（47.1% vs 31.3%, P=0.365）, while the pregnancy loss rate was higher in group B than in group A（29.4% vs 56.3%, P=0.117）, but the difference was not statistically significant. ConclusionsThe severity of IUAs was associated with the degree of injury of uterine JZ. Especially, when JZ was completely injured, it was meant to have severe IUAs. For IUAs, injured uterine JZ may significantly decrease the postoperative pregnancy rate and live-birth delivery rate, and increase in the pregnancy loss rate. Evaluation of JZ may of er new perspectives to estimate the severity of IUA and the outlook of pregnancy. So it is recommended to evaluate the degree of injury of uterine JZ as an independent predictor for postoperative pregnancy outcome of IUAs. For severe IUAs, once JZ was extensively or completely injured, the outcome of pregnancy may be very poor.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2016年第4期301-306,共6页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金(81000245
81370703)
国家"十二五"科技支撑计划项目(2012BAI32B05)~~
关键词
宫腔粘连
磁共振成像
子宫结合带
妊娠结局
预后
intrauterine adhesions
magnetic resonance imaging
uterine junctional zone
pregnancy outcome
prognosis
