Kdous M, Hachicha R, Zhiou F, Ferchiou M, Chaker A, Meriah S
Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Aziza-Othmana, 1000 Tunis, Tunisie.
Gynecol Obstet Fertil. 2003 May;31(5):422-8. doi: 10.1016/s1297-9589(03)00101-2.
The main aim of the study was to evaluate the efficacy of hysteroscopy in the treatment of intra-uterine adhesions with infertility.
This retrospective study of patients with uterine synechias treated exclusively hysteroscopically included 120 cases: 109 of them (90.8%) low fertility patients, 110 (91.7%) with menstrual disorders and 2 (1.7%) with no others symptoms. Mean age was 34 years (range: 21-45 years). Operative hysteroscopy was performed in 155 cases including electrosection in 124 cases (80%) and a collapse in 31 cases (20%). A single endoscopic procedure was performed in 96 patients, 2 procedures in 17 patients, 3 in 3 patients and 4 in 4 patients. Mean follow-up was 26.8 months (range: 6-52 months).
Good anatomic results were achieved in 116 patients (96.7%) after 1, 2 or 3 hysteroscopic procedures. We obtained good results in 58.2% of the patients with menstrual disorders. One pregnancy was achieved in 49 of patients (44.9%) including: 35 childbirth, 13 abortions and 1 molar pregnancy.
Hysteroscopy, easy procedure, allowing reproducible treatment with low morbidity should be proposed as first intention treatment in all cases with synechia. Fertility prognosis is tightly related to the gravity of synechia and its topography.
本研究的主要目的是评估宫腔镜检查在治疗伴有不孕症的宫腔粘连中的疗效。
这项对仅接受宫腔镜治疗的子宫粘连患者的回顾性研究纳入了120例患者：其中109例（90.8%）为低生育力患者，110例（91.7%）有月经紊乱，2例（1.7%）无其他症状。平均年龄为34岁（范围：21 - 45岁）。155例患者接受了手术宫腔镜检查，其中124例（80%）进行了电切术，31例（20%）进行了粘连分离术。96例患者进行了单次内镜手术，17例患者进行了2次手术，3例患者进行了3次手术，4例患者进行了4次手术。平均随访时间为26.8个月（范围：6 - 52个月）。
在1、2或3次宫腔镜手术后，116例患者（96.7%）获得了良好的解剖学结果。月经紊乱患者中有58.2%取得了良好效果。49例患者（44.9%）实现了一次妊娠，包括：35例分娩、13例流产和1例葡萄胎妊娠。
宫腔镜检查操作简便，能进行可重复的治疗且发病率低，应作为所有粘连病例的首选治疗方法。生育预后与粘连的严重程度及其部位密切相关。
