Gaya Sule A, Adamu Ibrahim S, Yakasai Ibrahim A, Abubakar Sanusi
Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.
Ann Afr Med. 2012 Apr-Jun;11(2):65-9. doi: 10.4103/1596-3519.93526.
Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others.
There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis, giving a retrieval rate of 95%. The information extracted includes age, parity, and menstrual pattern, predisposing factors, treatment option, outcome, complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fisher's exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant.
There were 57 cases of IUA out of 4160 gynecological patients seen, giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3%), Caesarean section (C/S) (31.5%), manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4% each), and unexplained (3.7%). Mode of presentation was secondary amenorrhoea (50%), oligomenorrhoea (22.2%), and hypomenorrhoea (10%). As for the management, 68% had blind procedure while 25.9% had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3% resumed normal menses, 11.1% had oligomenorrhoea, hypomenorrhoea 13% and amenorrhoea 5.6%. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point, OR=2.27, CI 0.45-12.65, Fisher exact test (one-tailed) P=0.2184818.
There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA.
宫腔镜下粘连分解术已被证明能显著改善宫腔粘连（IUA）的治疗效果。我们科室的微创外科单元（MISU）最近购置了一台宫腔镜，该宫腔镜正用于宫腔镜下粘连分解术及其他手术。
57例被诊断为IUA的患者中，有54份病历可供分析，资料检索率为95%。提取的信息包括年龄、产次、月经模式、诱发因素、治疗方案、治疗效果、并发症及手术年份。使用Epi info 3.4.1版本对提取的数据进行分析。采用卡方检验（Fisher精确检验）来检验不同治疗方式的治疗效果是否存在统计学差异。P值小于0.05被认为具有统计学意义。
在4160例妇科患者中，共发现57例IUA患者，患病率为14/1000。平均年龄为28.9岁（标准差4.5），平均产次为1.4（标准差1.4）。病因包括刮宫术（D和C）（33.3%）、剖宫产术（C/S）（31.5%）、人工剥离胎盘和盆腔炎（PID）（各占7.4%）以及不明原因（3.7%）。临床表现为继发性闭经（50%）、月经过少（22.2%）和经量过少（10%）。在治疗方面，68%的患者接受了盲目手术，25.9%的患者接受了宫腔镜手术。除3例使用小儿Foley导管替代的患者外，其余均使用Lippes环。随访时，59.3%的患者月经恢复正常，11.1%的患者月经过少，13%的患者经量过少，5.6%的患者闭经。以月经恢复正常作为终点，宫腔镜下粘连分解术与盲目手术的治疗效果无统计学差异，OR = 2.27，CI 0.45 - 12.65，Fisher精确检验（单尾）P = 0.2184818。
盲目手术与宫腔镜手术之间无显著差异。刮宫术被发现是IUA最常见的病因。
