宫腔镜宫腔粘连分离术45例分析

目的:探讨宫腔镜手术诊治宫腔粘连的疗效。方法:回顾性分析45例宫腔粘连患者宫腔镜诊治情况。结果:45例患者宫腔粘连分解术均在宫腔镜下顺利完成,无一例发生并发症。术后3~6月患者宫腔镜下随访发现宫腔成形完好34例,宫腔成形基本满意11例。术后患者月经变化:恢复正常经量34例(75.56%),较术前明显增多但未恢复正常经量8例(17.78%),较前仅稍增多3例(6.67%)。结论:宫腔镜是诊疗宫腔粘连的一种最有效的方法。     

宫腔镜粘连松解术中三种宫腔屏障方式治疗宫腔粘连的疗效及对再粘连的预防效果

目的 探讨宫腔镜粘连松解术（TCRA）中应用三种不同宫腔屏障方式治疗宫腔粘连（IUA）的疗效及对再粘连的预防效果。方法 将123例拟行TCRA的中、重度IUA患者随机均分为A组、B组与C组各41例。A组放置Foley球囊,B组留置宫内节育器（IUD）,C组采用透明质酸钠-羧甲基纤维素防粘连膜（HA/CMC）+IUD。比较三组的临床疗效,术前及术后3个月评价[美国生育学会（AFS）]宫腔粘连评分,随访3个月统计IUA复发率。结果 治疗后,三组的AFS评分均显著降低,且C组显著低于A组和B组（P <0.05）。C组再粘连率为9.76%,显著低于A组的26.83%和B组的36.59%(P <0.05)。C组月经恢复率87.80%,显著高于A组73.17%和B组63.41%(P <0.05)。结论 在IUA患者的TCRA中留置IUD+HA/CMC对预防复发的效果优于置入Foley球囊或留置IUD。     

宫腔粘连分离术后预防再粘连的临床研究

<正>宫腔粘连(intrauterine adhesion,IUA)主要是由刮宫和感染引起的,临床主要表现为闭经或月经过少、周期性腹痛等。宫腔镜下行IUA分离术(transcervical resection of adhesions,TCRA)是在直视下有针对性地分离或切除IUA,是患者恢复正常月经、改善妊娠及分娩结局的标准方法,但术后可能发生宫腔再次粘连。2009年1月至2012年6月我院采用两种不同的治疗方法预防宫腔再次粘连,以探讨有效的预防方法。1资料与方法1.1一般资料选取上述期间江苏大学附属宜兴医院宫腔     

宫腔镜分离粘连手术治疗不同程度宫腔粘连的效果观察

目的 观察宫腔镜分离粘连手术对于不同程度宫腔粘连患者的治疗效果。方法 选取46例宫腔粘连患者,根据宫腔粘连累及宫腔范围不同分为A组（范围1/3～2/3）与B组（范围2/3以上）,每组23例。两组均采取宫腔镜分离粘连手术治疗,观察对比两组患者治疗前后宫腔粘连情况、月经量、子宫体积、子宫内膜厚度及临床疗效。结果 治疗前,两组宫腔粘连评分、月经量、子宫体积及子宫内膜厚度比较,差异无统计学意义（P>0.05）;治疗后,A组宫腔粘连评分显著低于B组,月经量多于B组,子宫体积和子宫内膜厚度显著高于B组,差异具有统计学意义（P<0.05）。A组患者治疗总有效率为95.65%,明显高于B组的73.91%,差异具有统计学意义（P<0.05）。结论 宫腔镜分离粘连手术对不同程度宫腔粘连患者的治疗效果不同。宫腔粘连程度越严重,对患者的宫腔分离及月经量、子宫的体积、子宫内膜的厚度恢复就越困难,治疗效果越差。     

中重度宫腔粘连分离术后预防宫腔再粘连的临床效果观察

目的:探讨中重度宫腔粘连分离术后预防宫腔再粘连的临床效果。方法:回顾性分析2013年1月至2014年6月在武汉大学人民医院就诊的119例经宫腔镜检查确诊为中重度宫腔粘连并行TCRA术患者的临床资料。术后宫腔放置Foley球囊导尿管+宫内节育器为A组,宫腔放置Foley球囊导尿管+宫内节育器+可吸收医用膜为B组,术后均使用人工周期。比较患者的术后月经改善、宫腔及妊娠情况。结果:中度宫腔粘连患者中,B组的治愈率高于A组(57.7%vs 31.0%,P=0.047),宫腔再粘连率低于A组(15.4%vs 44.8%,P=0.018);A、B组的妊娠率分别为40%、60%,差异无统计学意义(P=0.37)。重度宫腔粘连患者中,B组的治愈率高于A组(43.8%vs 18.8%,P=0.031),宫腔再粘连率低于A组(15.6%vs 46.9%,P=0.007);A、B组的妊娠率分别为11.1%和33.3%,差异无统计学意义(P=0.257)。结论:中重度宫腔粘连分离术后联合使用Foley球囊导尿管+宫内节育器+可吸收医用膜治疗效果优于Foley球囊导尿管+宫内节育器组。     

宫腔镜手术治疗宫腔粘连的疗效分析

目的：探讨宫腔粘连采用宫腔镜手术治疗的效果。方法：本次研究选择的对象共60例,均为我院2012年1月至2013年1月收治的宫腔粘连患者,随机按观察组和对照组各30例划分,观察组采用宫腔镜手术治疗,对照组采用传统扩宫术治疗,回顾两组临床资料。结果：观察组有生育要求者23例,妊娠率为69．6％;月经不调27例,治疗后月经恢复正常率为88．9％;下腹痛12例,缓解率为91．7％。对照组有生育要求24例,妊娠率为50％;月经不调26例,治疗后月经恢复正常率为65．4％;下腹痛13例,缓解率为76．9％。各指标差异均有统计学意义（P〈0．05）。结论：采用宫腔镜手术治疗宫腔粘连,可显著提高临床效果,降低不良事件发生率,具有非常积极的临床意义。     

宫腔镜下宫腔粘连电切术68例近期临床效果的观察

目的:探讨宫腔镜下宫腔粘连电切术(TCRA)治疗宫腔粘连的近期疗效及安全性。方法:回顾分析2011年10月至2013年9月于我院应用连续灌流式宫腔镜行电切治疗的68例宫腔粘连患者的临床资料。电切术后宫腔放置节育环,术后补充雌激素。治疗3个月后,再次行宫腔镜检查,了解宫腔恢复及月经改善情况。结果:宫腔粘连程度与宫腔操作次数有关,而月经异常与宫腔粘连程度有关。宫腔镜术后,患者月经异常均得到不同程度的改善,月经改善总有效率91.30%;闭经、月经减少及月经紊乱的改善率分别为86.95%、94.44%和100%。宫腔镜术后3个月再次行宫腔镜检查,宫腔形态恢复正常,1例再次粘连。术中出现并发症8例,2例穿孔、3例止血困难、3例出现假窦道。结论:宫腔镜下宫腔粘连电切术具有微创、安全、有效等特点,可明显改善月经情况,同时行超声监测使手术更安全。     

COOK球囊联合雌孕激素序贯治疗预防宫腔镜下宫腔粘连分离术后宫腔再粘连的临床效果观察

目的:探讨宫腔镜下宫腔粘连(IUA)分离术后COOK球囊联合雌孕激素对预防宫腔再次粘连的临床效果,并探讨COOK球囊留置的时间。方法:选择我院2016年4月至2017年10月中重度IUA患者227例,随机分为4组:其中A组55例放置COOK球囊作为观察组A组,7天后取出;B组68例放置COOK球囊作为观察组B组,3月后取出;C组64例放置"宫型"宫内节育器(IUD)为观察组C组,3个月后取出;D组40例仅行宫腔镜下IUA分离术,作为空白对照组D组。4组术后第2天开始均应用戊酸雌二醇片(2 mg,每天3次,口服)联合地屈孕酮片(10 mg,每天1次,口服)序贯治疗,连续用药3个周期。分别比较4组治疗前后子宫腔状态、月经情况、妊娠率、患者满意度及有无并发症等。结果:治疗3个月后,B组IUA改善率、月经改善率、妊娠率及患者满意度均高于A组、C组、D组,差异有统计学意义(P0.05);B组植入物脱落率和嵌顿率明显低于C组(P0.05);B组与C组细菌感染率差异无统计学意义(P0.05)。结论:宫腔内放置COOK球囊3个月联合雌孕激素序贯治疗预防宫腔镜下IUA分离术后宫腔再粘连的方法在临床上的安全性及有效性均值得肯定。     

宫腔镜治疗宫腔粘连45例临床分析

目的:探讨宫腔镜诊治宫腔粘连的临床价值。方法:对2008年1月至2010年1月在我院行宫腔镜诊治手术的45例患者的临床资料进行回顾性分析。结果:术后恢复正常月经患者33例,占73.3%;在痛经的6例患者中,6例术后得到缓解或治愈。结论:宫腔镜是诊治宫腔粘连的首选方法,值得临床推广应用。     

重度宫腔粘连分离术后预防再粘连方法的比较

目的评估宫腔镜宫腔粘连分离术后预防宫腔再粘连方法的疗效。方法回顾性分析2004年11月至2007年5月间郑州大学第三附属医院妇科内镜诊治中心122例宫腔镜下宫腔粘连切除术患者的临床资料。术后宫腔内放置节育环(IUD)58例为IUD组,宫腔注入几丁糖并IUD64例为IUD+几丁糖组;根据病程长短将IUD组分为Ia组(病程≤1年)和Ib组(病程1年),IUD+几丁糖组分为IIa组(病程≤1年)和IIb组(病程1年)。观察术后宫腔恢复情况、月经改善及妊娠情况。结果IUD和IUD+几丁糖组术后宫腔再粘连率分别为41.4%和23.4%(P0.05),其中Ia组(19.0%)明显低于Ib组(54.1%)(P0.05);IUD组月经改善率及妊娠率分别为74.1%和29.3%,IUD+几丁糖组分别为92.2%和48.4%,IUD组明显低于IUD+几丁糖组(P0.05),其中Ia组(90.0%、47.6%)明显高于Ib组(64.9%、18.9%)(P0.05)。IIa组术后宫腔再粘连率及妊娠率分别为8.7%和78.3%,IIb组分别为31.7%和31.7%,两组比较,差异均有统计学意义(P0.05);IIa组(100%)月经改善率与IIb组(87.8%)比较,差异无统计学意义(P0.05)。结论重度宫腔粘连切除术后宫腔内放置节育环加几丁糖可有效预防再粘连,提高月经改善率及妊娠率。     

493例宫腔粘连患者的临床资料分析

目的:探讨宫腔粘连(IUA)患者粘连程度的高危影响因素。方法:回顾2012年1月至2014年6月北京大学第三医院生殖医学中心经宫腔镜确诊的493例IUA患者的临床资料,根据粘连程度分组,分析影响粘连程度的相关因素。结果:不同粘连程度IUA患者的平均年龄、月经周期和中孕妊娠丢失情况比较,差异均无统计学意义(P0.05);不同粘连程度IUA患者的月经量、原发不孕几率、结核病史和内膜炎情况均存在显著差异(P0.05);随着粘连程度的增加,经量减少、原发不孕及结核病史的患者所占的比例逐渐增加,而合并内膜炎患者的比例呈下降趋势。IUA粘连程度与妊娠相关的宫腔操作有关(P0.05),随着宫腔操作次数的增加,Ⅲ~Ⅴ度IUA患者明显增加。41.48%的IUA患者的子宫内膜超声结果正常,不同粘连程度患者的超声表现存在显著差异(P0.001),但随着粘连程度的加重,超声确诊粘连的比例无上升趋势。444例Ⅰ~Ⅲ度IUA患者中,内膜受损部位以中部居多,占45.05%;按粘连程度分组后,各组粘连部位存在统计学差异(P0.001),宫腔右侧粘连的比例明显高于左侧。结论:积极治疗感染性疾病,尽量减少宫腔创伤性操作,有助于避免IUA的发生;二维超声诊断IUA的敏感性低,宫腔镜检查是诊断IUA的金标准。     

The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications

Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy. Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was made to lyse them. Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60% of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one (P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to determine the subsequent reproductive outcome revealed similar conception rates in both groups. Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery.     

自交联透明质酸钠凝胶预防中重度宫腔粘连分离手术后再粘连的前瞻性、随机、阴性对照临床研究

目的 评价自交联透明质酸钠凝胶预防中重度宫腔粘连分离手术后再粘连的有效性和安全性.方法 前瞻性、多中心、随机、阴性对照临床研究;对2011年11月至2012年11月中南大学湘雅三医院等医院符合入组标准的宫腔粘连患者,根据美国生育学会(AFS)宫腔粘连评分分级标准进行宫腔镜下的术前诊断分级,中重度宫腔粘连患者纳入本研究.随机入组120例患者(试验组和对照组各60例),对试验组患者在宫腔镜粘连分离术后应用Foley球囊导尿管结合自交联透明质酸钠凝胶防止术后再粘连;对照组患者在宫腔镜粘连分离术后只用Foley球囊导尿管防止术后再粘连.在术后3个月时进行第2次宫腔镜检查,再次对宫腔粘连进行分级.主要评价指标:术后3个月时防止宫腔粘连的有效率.次要评价指标:对宫腔粘连累及范围、粘连类型、月经模式的得分进行手术前后和组间比较.结果 完成本研究的患者共111例,其中试验组55例、对照组56例.试验组自交联透明质酸钠凝胶防止术后宫腔粘连的有效率(76％,42/55)明显高于对照组(48％,27/56),两组比较,差异有统计学意义(P=0.000 9).试验组应用自交联透明质酸钠凝胶显著减少了AFS总分,试验组为(2.1±1.1)分,对照组为(3.7±2.5)分,两组比较,差异有统计学意义(P=0.000 8);并对宫腔粘连累及范围得分[试验组(1.3±0.5)分,对照组(1.7±0.8)分]和月经模式得分[试验组(0.8±1.1)分,对照组(1.4±1.1)分]均有明显改善(P=0.037 8、0.0004).试验组应用自交联透明质酸钠凝胶减少了术后再粘连(中度和重度)的发生率,试验组术后3个月时中重度宫腔粘连的发生率为13％(7/55),而对照组为38％(21/56),两组比较,差异有统计学意义(P=0.000 6).未发生与材料相关的不良事件和并发症.结论 自交联透明质酸钠凝胶能够有效减少中重度宫腔粘连分离手术后的再粘连发生率并降低粘连严重程度,有利于改善患者的月经情况.     

宫腔粘连模型大鼠子宫内膜胞饮突发育和整合素β3表达

目的:建立宫腔粘连大鼠模型,观察子宫内膜胞饮突的发育和整合素β3的表达,探讨宫腔粘连对子宫内膜容受性的影响。方法:选取健康SD大鼠30只,将每只大鼠左侧子宫作为模型组(宫腔注入95%无水乙醇,持续5min),右侧子宫作为对照组(注入等量生理盐水)。术后两个动情周期取子宫,光镜观察子宫内膜形态学变化及纤维化程度,扫描电镜观察大鼠子宫内膜胞饮突的发育情况,免疫组化法检测子宫内膜整合素β3表达。结果:模型组大鼠子宫内膜明显变薄,上皮细胞排列紊乱,间质内胶原纤维增多,子宫内膜纤维化评分为(4.69±0.22)分,明显高于对照组。扫描电镜观察,对照组大鼠子宫内膜可见大量发育完全的胞饮突,而模型组子宫内膜胞饮突分布稀少,表面皱缩,发育不同步。模型组的整合素β3表达明显低于对照组,差异有统计学意义(P0.05)。结论:注射无水乙醇可建立稳定的大鼠宫腔粘连动物模型,抑制子宫内膜胞饮突和整合素β3表达,降低子宫内膜的容受性。     

A comparison of intrauterine balloon,intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

Objective

To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome.

Study design

Retrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system.

Results

Both the intrauterine balloon group and the IUD group achieved significantly (P < 0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P < 0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups.

Conclusion

The insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.     

Intercoat (Oxiplex/AP Gel) for Preventing Intrauterine Adhesions After Operative Hysteroscopy for Suspected Retained Products of Conception: Double-Blind,Prospective, Randomized Pilot Study

Study ObjectiveTo evaluate the safety and effectiveness of Oxiplex/AP gel (Intercoat) in reducing intrauterine adhesion formation after hysteroscopic treatment because of retained products of conception (RPOC).DesignProspective double-blind, randomized, controlled pilot study (Canadian Task Force classification I).SettingTertiary medical center.PatientsAll women who underwent hysteroscopic treatment because of RPOC at our institution between September 2009 and June 2012 were invited to participate. After operative hysteroscopy, participants were randomized to either have their uterine cavity filled with Oxiplex/AP gel (study group, n = 26) or not (control group, n = 26).InterventionsDiagnostic office hysteroscopy to assess for adhesion formation was performed after 6 to 8 weeks. Findings were graded according to the American Fertility Society classification. Rates of subsequent pregnancy in the 2 groups were assessed.Measurements and Main ResultsIntraoperative complication rates were similar between the 2 groups. There were no postoperative complications after Oxiplex/AP gel application. Moderate to severe adhesions developed in 1 woman (4%) in the study group and 3 (14%) in the control group (p = .80). During follow-up of 20 months (range, 2–33 months), 7 women (27%) in the treatment group conceived, compared with 3 (14%) in the control group (p = .50).ConclusionIntrauterine application of Oxiplex/AP gel after hysteroscopic removal of RPOC is safe. In this small sample, the difference in the rate of intrauterine adhesions was not statistically significant. A larger study would enable further establishment of the safety and efficacy of use of this gel.     

Comparison of pretreatment assessment of intrauterine tumor spread in endometrial carcinoma using ultrasonography,hysteroscopy, and fractional curettage

Due to their age, patients with endometrial carcinoma are often in an impaired general condition and have other concomitant diseases. To prevent overtreatment or undertreatment, invasive and noninvasive diagnostic procedures such as ultrasonography, hysteroscopy, and fractional curettage were compared with regard to their capacity to assess tumor extent (in) to the cervix. In 75 patients with endometrial carcinoma, the results of transvaginal ultrasonography, diagnostic hysteroscopy, and fractional curettage in assessing tumor spread to the cervix were compared with the final pathology report on the hysterectomy specimen. Cervical involvement was demonstrated in the hysterectomy specimen in 25.3% of the patients (19 of 75). Ultrasound identified evidence of cervical involvement with a sensitivity of 15.8% (3 of 19) and a specificity of 98.1% (53 of 54); hysteroscopy had a sensitivity of 42.9% (6 of 14) and a specificity of 89.5% (34 of 38); and fractional curettage had a sensitivity of 57.9% (11 of 19) and a specificity of 66.1% (37 of 56). None of the procedures on its own is suitable for pretreatment assessment of cervical involvement. However, negative endocervical curettage and hysteroscopical exclusion of cervical infiltration may often identify patients correctly without cervical involvement, thereby avoiding overtreatment.     

Meta-analysis on the use of hyaluronic acid gel to prevent recurrence of intrauterine adhesion after hysteroscopic adhesiolysis

Intrauterine adhesion is a severe complication after intrauterine operation, Various adjuvant therapies failed to improve clinical symptoms and pregnancy rates among patients with moderate-to-severe intrauterine adhesion. At present, hyaluronic acid gel is widely used in the primary prevention of adhesion after hysteroscopic adhesiolysis. However, its efficacy is still under debate. Therefore, the aim of this study was to systematically evaluate the efficacy of hyaluronic acid gel in preventing the recurrence of intrauterine adhesion after hysteroscopic adhesiolysis. The Cochrane Library, Embase, and PubMed databases were used to search for articles published before July 31, 2018, using the following terms: hyaluronic acid, intrauterine adhesions, Asherman's syndrome, IUA, hysteroscopy, and hysteroscopic adhesiolysis. Studies on therapies after hysteroscopic adhesiolysis were collected. The recurrence rate of and pregnancy rate in the presence of intrauterine adhesion after hysteroscopic adhesiolysis were analyzed by RevMan 5.3 software. A total of 6 articles were selected, which included 394 patients who were subjected to hysteroscopic adhesiolysis. The meta-analysis results showed that (1) no statistically significant difference was found between hyaluronic acid gel use and without its use on the score of intrauterine adhesion after hysteroscopic adhesiolysis [the mean difference (MD) = ?0.89, 95% confidence interval (CI) (?2.53–0.76), P = 0.29], neither a statistically significant difference was observed between the same groups on the recurrence rate of intrauterine adhesion [odds ratio (OR) = 0.75, 95% CI (0.31–1.81), P = 0.53]; (2) subgroup analysis showed that hyaluronic acid gel could reduce the rate of intrauterine adhesion recurrence in randomized controlled trials [OR = ?0.28, 95% CI (0.14–0.56), P = 0.0006]. However, the recurrence rate of intrauterine adhesion after the use of hyaluronic acid gel was not statistically significant in non-randomized controlled experiments [OR = 1.53, 95% CI (0.79–2.95), P = 0.21]; (3) hyaluronic acid gel did not result in a significant effect on pregnancy rate after intrauterine adhesion separation [OR = 2.02, 95% CI (0.53–7.66), P = 0.3]. In conclusion, hyaluronic acid gel could reduce the recurrence rate of intrauterine adhesion, but had no significant effect on the postoperative pregnancy rate.