宫腔粘连与宫腔镜胚物残留术后生育力结局分析：400例单中心回顾性研究

doi:10.3969/j.issn.1006-7795.2026.02.018

首都医科大学学报 ›› 2026, Vol. 47 ›› Issue (2): 360-365.doi: 10.3969/j.issn.1006-7795.2026.02.018

宫腔粘连与宫腔镜胚物残留术后生育力结局分析：400例单中心回顾性研究

杨雪¹,马宁¹,杨玲玲¹,黄晓武^1*,夏恩兰¹,李天照²

1.首都医科大学附属复兴医院宫腔镜中心，北京 100038；2.仁安医院生殖医学中心，香港 999077

收稿日期:2025-09-22 修回日期:2026-01-04 出版日期:2026-04-21 发布日期:2026-04-21
通讯作者: 黄晓武 E-mail:hxiaowu_fxyy@126. com
基金资助:
北京市教育委员会科研计划项目（KM202410025009）。

Reproductive outcomes after hysteroscopic removal of retained products of conception in patients with intrauterine adhesions: a single-center retrospective study of 400 cases

Yang Xue¹, Ma Ning¹, Yang Lingling¹， Huang Xiaowu^1*, Xia Enlan¹, Li Tinchiu²

1. Hysteroscopic Center, Department of Obstetric and Gynecological, Fuxing Hospital, Capital Medical University, Beijing 100038, China; 2. Union Hospital Reproductive Medicine Centre, Hong Kong 999077, China

Received:2025-09-22 Revised:2026-01-04 Online:2026-04-21 Published:2026-04-21
Supported by:
The study was supported by the R&D Program of Beijing Municipal Education Commission（KM202410025009）.

摘要/Abstract

摘要： 目的回顾性分析胚物残留患者术中宫腔镜直视下是否合并宫腔粘连与术后宫腔粘连率、妊娠率及妊娠方式等生殖结局之间的关系，并进一步探讨影响术后活产的相关因素，建立胚物残留生殖结局预测模型，为临床预测与干预提供数据支持。方法回顾性分析首都医科大学附属复兴医院2017年1月至2023年12月接受宫腔镜下胚物残留清除术的400例患者临床资料。根据术中宫腔镜直视下是否发现宫腔粘连分为粘连组（150例）和非粘连组（250例），比较两组一般资料及术后生育结局差异，以术后活产为因变量，并采用多因素Logistic回归分析影响术后活产的相关因素，建立胚物残留生殖结局预测模型，采用受试者工作特性(receiver operating characteristic, ROC)曲线评估模型的区分能力。结果粘连组患者既往刮宫次数及既往宫腔粘连史比例显著高于非粘连组（P<0.05）。术后妊娠率（54.7% vs 79.2%）、显著低于非粘连组（P<0.001）；在妊娠者中，粘连组活产率低于非粘连组［72.0%（59/82）vs 83.3%（165/198），P=0.043］，受孕时间中位数延长［9(6～15)个月 vs 5(3～9)个月，P<0.001］。多因素Logistic回归显示，术中宫腔粘连（aOR=0.520，95%CI：0.353～0.774，P<0.001）和术后宫腔粘连（aOR=0.571，95%CI：0.372～0.880，P=0.012）是术后活产率降低的独立危险因素，而术后使用预防宫腔粘连辅助治疗为保护因素（aOR=1.492，95%CI：1.021～2.173，P=0.038）。胚物残留生殖结局预测模型预测术后活产的曲线下面积为0.656，提示模型在统计学上具有一定区分能力，但临床预测效能有限。结论术中宫腔镜直视下发现宫腔粘连的胚物残留患者术后妊娠率和活产率明显低于无宫腔粘连者，且受孕时间长。术中及术后宫腔粘连是影响术后活产，加强术中评估并联合术后预防宫腔粘连辅助治疗，可能有助于改善患者生育结局。

关键词: 宫腔镜, 胚物残留, 宫腔镜胚物残留切除术, 宫腔粘连, 生育力结局, 预测模型

Abstract: Objective To investigate the relationship between intrauterine adhesions (IUA) detected under hysteroscopy during retained products of conception (RPOC) removal and postoperative reproductive outcomes, including postoperative IUA, pregnancy rate, and mode of conception, and to explore factors affecting postoperative live birth. A predictive model for reproductive outcomes was also established.Methods Clinical data of 400 patients who underwent hysteroscopic RPOC removal at Fuxing Hospital, Capital Medical University from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into adhesion (n=150) and non-adhesion (n=250) groups according to intraoperative hysteroscopic findings. Baseline characteristics and postoperative reproductive outcomes were compared. Multivariate Logistic regression was used to identify factors associated with postoperative live birth, and a predictive model was evaluated using receiver operating characteristic (ROC) curve analysis.Results The adhesion group had significantly higher rates of previous curettage and prior IUA history than the non-adhesion group (P<0.05). Postoperative pregnancy rate was lower in the adhesion group (54.7% vs 79.2%, P<0.001). Among pregnant patients, the live birth rate was lower in the adhesion group than in the non-adhesion group ［72.0% (59/82) vs 83.3% (165/198), P=0.043］, and median time to conception was prolonged ［9 (6－15) months vs 5 (3－9) months, P<0.001］. Multivariate Logistic analysis showed that intraoperative IUA (adjusted OR=0.520, 95% CI: 0.353－0.774, P<0.001) and postoperative IUA (adjusted OR=0.571, 95% CI: 0.372－0.880, P=0.012) were independent risk factors for reduced live birth, while postoperative anti-adhesion therapy exerted protective effect (adjusted OR=1.492, 95% CI: 1.021－2.173, P=0.038). The RPOC fertility prediction model predicted postoperative live birth with an area under the curve (AUC) of 0.656, indicating moderate discriminative ability.Conclusion In RPOC patients, intraoperative IUA is associated with lower postoperative pregnancy and live birth rates but longer time to conception. Both intraoperative and postoperative adhesions reduce live birth rates, whereas postoperative anti-adhesion therapy may improve reproductive outcomes.

Key words: hysteroscopy, retained products of conception, hysteroscopic resection of retained products of conception, intrauterine adhesions, reproductive outcomes, prediction model

中图分类号:

杨雪, 马宁, 杨玲玲, 黄晓武, 夏恩兰, 李天照. 宫腔粘连与宫腔镜胚物残留术后生育力结局分析：400例单中心回顾性研究[J]. 首都医科大学学报, 2026, 47(2): 360-365.

Yang Xue, Ma Ning, Yang Lingling, Huang Xiaowu, Xia Enlan, Li Tinchiu. Reproductive outcomes after hysteroscopic removal of retained products of conception in patients with intrauterine adhesions: a single-center retrospective study of 400 cases[J]. Journal of Capital Medical University, 2026, 47(2): 360-365.

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宫腔粘连与宫腔镜胚物残留术后生育力结局分析：400例单中心回顾性研究

Reproductive outcomes after hysteroscopic removal of retained products of conception in patients with intrauterine adhesions: a single-center retrospective study of 400 cases

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