Guerin Aline Rocha, Lopes Reginaldo Guedes Coelho, Depes Daniella de Batista, Martins João Alfredo
Curso de Pós-Graduação, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, Brasil.
Serviço de Ginecologia e Obstetrícia, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, Brasil.
Rev Bras Ginecol Obstet. 2014 Apr;36(4):170-5. doi: 10.1590/s0100-720320140050.0001. Epub 2014 Mar 25.
To examine the aspect of the uterine cavity after hysteroscopic endometrial ablation, to determine the prevalence of synechiae after the procedure, and to analyze the importance of hysteroscopy during the postoperative period.
The results of the hysteroscopic exams of 153 patients who underwent outpatient hysteroscopy after endometrial ablation due to abnormal uterine bleeding of benign etiology during the period from January 2006 to July 2011 were retrospectively reviewed. The patients were divided into two groups: HIST≤60 (n=90) consisting of patients undergoing the exam 40-60 days after the ablation procedure, and the group HIST>60 (n=63) consisting of patients undergoing the exam between 61 days and 12 months after the procedure.
In the HIST≤60 group, 30% of the patients presented some degree of synechiae: synechiae grade I in 4.4% of patients, grade II in 6.7% , grade IIa in 4.4%, grade III in 7.8%, and grade IV in 2.2%. In the HIST>60 group, 53.9% of all cases had synechiae, 3.2% were grade I, 11.1% grade II, 7.9% grade IIa, 15.9% grade III, and 4.8% grade IV. Hematometra was detected in 2.2 % of all cases in group HIST≤60 and in 6.3% of all cases in group HIST>60.
The uterine cavity of the patients submitted to diagnostic hysteroscopy up to 60 days after endometrial ablation showed significantly fewer synechiae compared to the uterine cavity of patients who underwent the exam after 60 days. Long-term follow-up is necessary to fully evaluate the importance of outpatient hysteroscopy after endometrial ablation regarding menstrual patterns, risk of cancer and prevalence of treatment failure.
检查宫腔镜子宫内膜切除术后子宫腔的情况，确定术后粘连的发生率，并分析术后宫腔镜检查的重要性。
回顾性分析2006年1月至2011年7月期间因良性病因子宫异常出血而接受门诊宫腔镜检查的153例患者的宫腔镜检查结果。患者分为两组：HIST≤60组（n = 90），包括在切除术后40 - 60天接受检查的患者；HIST>60组（n = 63），包括在术后61天至12个月之间接受检查的患者。
在HIST≤60组中，30%的患者出现了一定程度的粘连：I级粘连占4.4%，II级占6.7%，IIa级占4.4%，III级占7.8%，IV级占2.2%。在HIST>60组中，53.9%的病例有粘连，I级占3.2%，II级占11.1%，IIa级占7.9%，III级占15.9%，IV级占4.8%。HIST≤60组所有病例中有2.2%检测到积血，HIST>60组所有病例中有6.3%检测到积血。
与术后60天后接受检查的患者子宫腔相比，子宫内膜切除术后60天内接受诊断性宫腔镜检查的患者子宫腔粘连明显较少。需要长期随访以充分评估子宫内膜切除术后门诊宫腔镜检查对月经模式、癌症风险和治疗失败发生率的重要性。
