探讨经腹部超声实时引导在重度宫腔粘连宫腔镜手术中的应用价值。

回顾性分析2017年1月至2019年6月因重度宫腔粘连在南京鼓楼医院妇科手术室接受宫腔镜手术治疗的患者236例，所有患者均接受宫腔镜下粘连分离及治疗手术，并于术前接受专项超声检查、术中行经腹部超声实时引导及监护。

236例重度宫腔粘连手术治疗病例中，粘连分离后脐带间充质干细胞或骨髓干细胞胶原膜支架植入共108例，节育环包裹生物膜植入15例，瘢痕化薄型子宫内膜生长因子内膜下多点注射71例。所有超声引导下宫腔镜手术均未发生术中子宫穿孔、异常出血，支架或生物膜植入到位，内膜下注射定位准确，宫腔解剖学形态基本恢复正常，手术成功率100%。

经腹部超声实时引导宫腔镜手术治疗重度宫腔粘连为手术精准性及安全性提供了可靠保障，具有降低手术风险、减少手术并发症等优点，值得临床推广应用。

To explore the value of real-time transabdominal ultrasound monitoring in hysteroscopic surgery for severe intrauterine adhesion.

Patients who received hysteroscopic adhesiolysis due to severe intrauterine adhesion at Nanjing Druw Tower Hospital from January 2017 to June 2019 were analyzed retrospectively. Transvaginal ultrasound and preoperative evaluation were performed routinely before the operation. Patients with complex surgery identified through clinical discussion and evaluation before surgery were given real-time monitoring by transabdominal ultrasound during the operation.

A total of 236 cases of severe intrauterine adhesion were included, all of which underwent hysteroscopic adhesiolysis. After the operation, 108 cases were implanted with umbilical cord mesenchymal stem cells or bone marrow stem cells on collagen membrane scaffolds, 15 cases were implanted with biological membrane wrapped by contraceptive ring, 71 cases of thin endometrium were injected with growth factor under the endometrium. No uterine perforation or abnormal bleeding occurred during surgery.

Real-time transabdominal ultrasound monitoring in hysteroscopic surgery for severe intrauterine adhesion has advantages of increasing the safety and success rate of the operation, decreasing the risk of the operation, and reducing the complications, which is worthy of clinical promotion.