Pabuccu Recai, Onalan Gogsen, Kaya Cemil, Selam Belgin, Ceyhan Temel, Ornek Turkan, Kuzudisli Ebru
Centrum Clinic, Ankara, Turkey.
Fertil Steril. 2008 Nov;90(5):1973-7. doi: 10.1016/j.fertnstert.2007.06.074. Epub 2008 Sep 6.
To highlight the efficiency of intrauterine device (IUD) guidance during hysteroscopic adhesiolysis for severe intrauterine adhesions.
A prospective, randomized trial.
Private tertiary and referral infertility clinic.
PATIENT(S): Seventy-one subfertile patients who underwent hysteroscopic treatment of intrauterine synechiae or adhesions.
INTERVENTION(S): Thirty-six women in group 1 were initially examined by laparoscopy-hysteroscopy at first look, and an IUD was inserted during hysteroscopic adhesiolysis. The adhesions were further lysed by the guidance of IUD during the second-look office hysteroscopy, 1 week later. Patients were prescribed 2 months of estrogen as well as P therapy, and the IUD was removed by the end of this period. The uterine cavity was evaluated, and adhesions were further lysed by a third-look office hysteroscopy, 1 week after the removal of IUD. Thirty-five women in group 2 were similarly examined by first-look office hysteroscopy, and an IUD was inserted during hysteroscopic adhesiolysis. These patients did not undergo early intervention of office hysteroscopy, 1 week after the first procedure. They also used 2 months of estrogen and P therapy. The IUD was removed by the end of this period, and the uterine cavity was evaluated and adhesions were further lysed during a second-look office hysteroscopy.
MAIN OUTCOME MEASURE(S): Pregnancy rate and live birth rate.
RESULT(S): Spontaneous pregnancy rates after treatment were 17/36 (47.2%) and 11/35 (30%), and live birth rates were 10/36 (28%) and 7/35 (20%) in groups 1 and 2, respectively. These differences between the two groups were not statistically significant.
CONCLUSION(S): The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes.
强调宫腔镜粘连松解术治疗重度宫腔粘连时宫内节育器（IUD）引导的有效性。
一项前瞻性随机试验。
私立三级及转诊不孕症诊所。
71例接受宫腔镜治疗宫腔粘连或粘连的亚生育患者。
第1组36名女性首先通过腹腔镜-宫腔镜进行初次检查，并在宫腔镜粘连松解术期间插入IUD。1周后，在第二次门诊宫腔镜检查时，在IUD引导下进一步松解粘连。患者接受2个月的雌激素和孕激素治疗，在此期间结束时取出IUD。取出IUD1周后，通过第三次门诊宫腔镜检查评估宫腔并进一步松解粘连。第2组35名女性同样通过初次门诊宫腔镜检查，在宫腔镜粘连松解术期间插入IUD。这些患者在第一次手术后1周未接受早期门诊宫腔镜干预。他们也使用了2个月的雌激素和孕激素治疗。在此期间结束时取出IUD，并在第二次门诊宫腔镜检查时评估宫腔并进一步松解粘连。
妊娠率和活产率。
治疗后的自然妊娠率在第1组和第2组分别为17/36（47.2%）和11/35（30%），活产率分别为10/36（28%）和7/35（20%）。两组之间的这些差异无统计学意义。
特别描述的早期干预方法可预防重度宫腔粘连治疗期间的并发症，并可能为获得良好的临床结局提供一种安全有效的替代方法。
