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宫腔粘连的综述。

Review of intrauterine adhesions.

机构信息

Department of Gynaecology, Royal Hospital for Women, and School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.

出版信息

J Minim Invasive Gynecol. 2010 Sep-Oct;17(5):555-69. doi: 10.1016/j.jmig.2010.04.016. Epub 2010 Jul 24.

Abstract

This article has been produced to review the literature on symptomatic and asymptomatic intrauterine adhesions. Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Current Contents, and EMBASE were searched using the Medical Subject Headings (MeSH), including all subheadings, and the keywords "Asherman syndrome," "Hysteroscopic lysis of adhesions," "Hysteroscopic synechiolysis," "Hysteroscopy and adhesion," "Intrauterine adhesions," "Intrauterine septum and synechiae," and "Obstetric outcomes after intrauterine surgery." The vast majority of evidence in the literature consists of uncontrolled case series, with only intrauterine adhesion barriers being assessed in a randomized controlled format. This article reviews epidemiology, pathologic features, classification systems, and treatments. Seven classification systems are described, with no universal acceptance of any one system and no validation of any of them. Hysteroscopy is the mainstay of both diagnosis and treatment, with medical treatments having no role in management. There is a wide range of treatment techniques with no controlled comparative studies, and assessments are descriptive and report fertility and menstrual outcomes, with more severe adhesions having the worst clinical outcomes. One of the most important features of treatment is prevention of recurrence, with the best available evidence demonstrating that newly developed adhesion barriers such as hyaluronic acid show promise for preventing new adhesions.

摘要

这篇文章旨在回顾有关症状性和无症状性宫腔粘连的文献。使用医学主题词 (MeSH) 包括所有副标题以及关键词“阿舍曼综合征”、“宫腔镜粘连松解术”、“宫腔镜粘连切除术”、“宫腔镜与粘连”、“宫内粘连”、“宫内纵隔和粘连”和“宫内手术后的产科结局”,在电子资源中搜索了 Medline、PubMed、CINAHL、考科蓝图书馆(包括考科蓝系统评价数据库)、Current Contents 和 EMBASE。文献中的绝大多数证据都是未对照的病例系列研究,只有宫内粘连屏障是以随机对照的方式进行评估的。本文回顾了流行病学、病理特征、分类系统和治疗方法。描述了七种分类系统,但没有一种系统被普遍接受,也没有一种系统得到验证。宫腔镜是诊断和治疗的主要方法,药物治疗在管理中没有作用。有多种治疗技术,但没有对照比较研究,评估是描述性的,报告了生育和月经结局,粘连越严重,临床结局越差。治疗的一个最重要的特征是预防复发,目前最好的证据表明,新开发的粘连屏障如透明质酸在预防新粘连方面显示出希望。

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