2026 年第 3 期 第 21 卷

宫腔镜手术与清宫术治疗早期稽留流产后宫腔粘连的相关因素分析

Analysis of factors related to intrauterine adhesions after hysteroscopic surgery versus curettage in the treatment of early missed abortion

作者：杨晓何玉梅沈欢欢杨丽菁李寅

英文作者：Yang Xiao He Yumei Shen Huanhuan Yang Lijing Li Yin

单位：云南省第三人民医院妇科，昆明650000

英文单位：Department of Gynecology the Third People′s Hospital of Yunnan Province Kunming 650000 China

关键词：宫腔粘连；稽留流产；宫腔镜手术；清宫术；子宫内膜血流

英文关键词：Intrauterineadhesions;Missedabortion;Hysteroscopicsurgery;Curettage;Endometrialbloodflow

• 摘要：

• 目的 分析宫腔镜手术与清宫术治疗早期稽留流产对发生宫腔粘连的相关因素。方法 选取2024年1月至2025年6月云南省第三人民医院收治的60例早期稽留流产患者作为研究对象，采用随机数字表法分为A组和B组，每组各30例。A组行常规清宫术，B组行宫腔镜下妊娠物清除术。比较2组患者手术指标、术后人绒毛膜促性腺激素（HCG）水平、月经恢复情况、子宫内膜厚度、内膜下血流的搏动指数（PI）和阻力指数（RI）、宫腔粘连情况。结果 B组手术时间、术中出血量、住院时长、术后阴道流血时间均短于/少于A组［(10.2±2.1)min比(14.7±2.0)min、(35.3±5.6)ml比(46.6±5.3)ml、(5.1±0.6)d比(6.3±0.7)d、(6.0±0.9)d比(7.8±1.0)d］，差异均有统计学意义（t=8.227、8.005、6.481、7.272，均P＜0.001）。随时间推移，2组HCG值均呈下降趋势，且B组术后24 h、1周、1个月HCG值均低于A组，差异均有统计学意义（均P＜0.05）。B组月经恢复时间、月经量减少比例均短于/低于A组，差异均有统计学意义（均P＜0.05）。术后3个月，2组子宫内膜厚度均大于术后1个月，且B组术后1、3个月子宫内膜厚度均大于A组［(5.8±0.8)mm比(4.4±0.7)mm、(8.0±0.9)mm比(6.2±0.8)mm］，差异均有统计学意义（t=7.859、8.094，均P＜0.001）。月经复潮第3个月时，2组PI和RI值均低于月经复潮第1个月时，且B组均低于A组［（1.52±0.29）比(2.17±0.41)、(0.62±0.06)比(0.75±0.09)］，差异均有统计学意义（t=7.089、6.583，均P＜0.001）。B组宫腔粘连发生率低于A组［6.7%（2/30）比26.7%（8/30）］，差异有统计学意义（χ2=4.320，P=0.038）。结论 宫腔镜手术较常规清宫术能减少早期稽留流产术后宫腔粘连发生，促进子宫内膜修复，改善子宫血流动力学，有利于保护患者生育功能，可作为早期稽留流产的首选术式。

• Objective To analyze the factors related to the occurrence of intrauterine adhesions after hysteroscopic surgery versus curettage in the treatment of early missed abortion. Methods A total of 60 patients with missed abortion admitted to the Third People′s Hospital of Yunnan Province from January 2024 to June 2025 were selected as the research objects. They were divided into group A and group B by random number table method, with 30 cases in each group. Group A underwent routine curettage, and group B underwent hysteroscopic removal of gestational products. The surgical indicators, postoperative human chorionic gonadotropin (HCG) levels, menstrual recovery, endometrial thickness, pulsatility index (PI) and resistance index (RI) of subendometrial blood flow, and intrauterine adhesions were compared between the two groups. Results The operation time, intraoperative blood loss, hospital stay, and postoperative vaginal bleeding time in group B were significantly shorter/less than those in group A ［(10.2±2.1)min vs (14.7±2.0)min, (35.3±5.6)ml vs (46.6±5.3)ml, (5.1±0.6)d vs (6.3±0.7)d, (6.0±0.9)d vs (7.8±1.0)d］（t=8.227, 8.005, 6.481, 7.272， all P＜0.001）. With the passage of time, the HCG values in both groups showed a downward trend, and the HCG values in group B at 24 h, 1 week, and 1 month after surgery were significantly lower than those in group A (all P＜0.05). The menstrual recovery time and the proportion of reduced menstrual volume in group B were significantly shorter/lower than those in group A (all P＜0.05). At 3 months after surgery, the endometrial thicknesses in both groups were significantly greater than those at 1 month after surgery, and the endometrial thicknesses in group B at 1 and 3 months after surgery were significantly greater than those in group A ［(5.8±0.8)mm vs (4.4±0.7)mm, (8.0±0.9)mm vs (6.2±0.8)mm］（t=7.859, 8.094， all P＜0.001）. At 3 months after menstrual resumption, the PI and RI values in both groups were significantly lower than those at 1 month after menstrual resumption, and those in group B were significantly lower than those in group A ［（1.52±0.29） vs (2.17±0.41), (0.62±0.06) vs (0.75±0.09)］（t=7.089, 6.583， all P＜0.001）. The incidence of intrauterine adhesions in group B was significantly lower than that in group A ［6.7%(2/30) vs 26.7%(8/30)］(χ2=4.320, P=0.038). Conclusion Compared with routine curettage, hysteroscopic surgery can reduce the occurrence of intrauterine adhesions after early missed abortion, promote endometrial repair, improve uterine hemodynamics, and is conducive to protecting patients′ reproductive function. It can be used as the preferred surgical method for missed abortion.