California Fertility Partners, Division of Gynecology, Keck School of Medicine of the University of Southern California, 11818 Wilshire Blvd, Third Floor, Los Angeles, CA 90025, USA.
Reprod Biomed Online. 2011 Jul;23(1):63-76. doi: 10.1016/j.rbmo.2010.11.018. Epub 2010 Dec 4.
Intrauterine adhesions (IUA) or Asherman's syndrome is a multifaceted condition which is being diagnosed with increasing frequency. Although it usually occurs following curettage of the pregnant or recently pregnant uterus, any uterine surgery can lead to IUA. Most women with IUA have amenorrhoea or hypomenorrhoea, but some have normal menses. Those who have amenorrhoea may also have cyclic pelvic pain secondary to 'trapped' menses and the accompanying retrograde menstruation may lead to endometriosis. In addition to menstrual disorders, most women with IUA will present with infertility or recurrent spontaneous abortion. Over the last four decades hysteroscopy has become the standard method to diagnose and treat this condition. Various techniques for adhesiolysis and for prevention of scar reformation have been advocated. The most efficacious appears to be the use of miniature scissors for adhesiolysis and the placement of a balloon stent inside the uterus immediately after surgery. Post-operative oestrogen therapy is prescribed in order to stimulate endometrial regrowth. Follow-up studies to assure resolution of the IUA are mandatory before the patient attempts to conceive as is careful monitoring of pregnancies for cervical incompetence, placenta accreta and intrauterine growth restriction.
宫腔粘连（IUA）或 Asherman 综合征是一种多方面的疾病，其诊断频率正在不断增加。尽管它通常发生在刮宫后的妊娠或近期妊娠子宫，但任何子宫手术都可能导致 IUA。大多数患有 IUA 的女性出现闭经或月经过少，但有些女性的月经正常。那些闭经的女性可能还会出现周期性盆腔疼痛，这是由于“被困”的月经引起的，伴随的逆行性月经可能导致子宫内膜异位症。除了月经紊乱，大多数患有 IUA 的女性还会出现不孕或反复自然流产。在过去的四十年中，宫腔镜检查已成为诊断和治疗这种疾病的标准方法。已经提倡了各种用于粘连松解和预防疤痕形成的技术。最有效的方法似乎是使用微型剪刀进行粘连松解，并在手术后立即在子宫内放置球囊支架。为了刺激子宫内膜再生，术后给予雌激素治疗。在患者尝试怀孕之前，必须进行后续研究以确保 IUA 得到解决，并且仔细监测妊娠以防止宫颈机能不全、胎盘植入和宫内生长受限。
