Yang J-H, Chen C-D, Chen S-U, Yang Y-S, Chen M-J
Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
BJOG. 2016 Mar;123(4):618-23. doi: 10.1111/1471-0528.13353. Epub 2015 Mar 6.
To investigate the recurrence potential of intrauterine adhesions after hysteroscopic adhesiolysis.
Retrospective observational study.
Tertiary university hospital.
This study included 115 women who had intrauterine adhesions completely separated during hysteroscopic surgery. The treated adhesions were classified into four groups according to their location and extent: Group 1, central type (i.e. intervening space between the adhesions and both lateral uterine sidewalls) at the middle area of uterine cavity; Group 2, central type at uterine cornua; Group 3, cervico-isthmic; and Group 4, extensive if the adhesions were dense with occlusion of part of the uterine cavity other than cervico-isthmic region.
Postoperative outpatient hysteroscopic adhesiolysis was scheduled 10-14 days after the initial hysteroscopic surgery and procedures were repeated every 10-14 days until no reformed adhesions were detected. Multivariate logistic regression models were built to examine initial adhesion characteristics and other factors associated with adhesion reformation and need for subsequent outpatient adhesiolysis. Categorical data were compared using Fisher's exact test.
Number of postoperative outpatient hysteroscopic adhesiolysis procedures.
The location and extent of adhesions according to the allocated group was the only parameter independently related to the number of postoperative outpatient adhesiolysis procedures (P = 0.0004). Women with Group 1 adhesions underwent a lower number of postoperative interventions compared with those with Group 2, 3 and 4 adhesions (P = 0.0355, P = 0.0004 and P = 0.0087, respectively).
There is an increased likelihood of intrauterine adhesion recurrence when successfully divided adhesions were originally located at the uterine cornua, the cervico-isthmic region or involved a large portion of the uterine cavity.
探讨宫腔镜粘连松解术后宫腔粘连的复发可能性。
回顾性观察研究。
三级大学医院。
本研究纳入了115例在宫腔镜手术中宫腔粘连完全分离的女性。根据粘连的位置和范围将治疗的粘连分为四组：第1组，宫腔中部中央型（即粘连与子宫两侧壁之间的间隙）；第2组，子宫角部中央型；第3组，宫颈峡部型；第4组，如果粘连致密且除宫颈峡部区域外部分宫腔闭塞则为广泛型。
在初次宫腔镜手术后10 - 14天安排术后门诊宫腔镜粘连松解术，每10 - 14天重复一次，直至未检测到新形成的粘连。构建多因素逻辑回归模型以检查初始粘连特征及其他与粘连再形成和后续门诊粘连松解术需求相关的因素。分类数据采用Fisher精确检验进行比较。
术后门诊宫腔镜粘连松解术的次数。
根据分组的粘连位置和范围是与术后门诊粘连松解术次数唯一独立相关的参数（P = 0.0004）。与第2、3和4组粘连的女性相比，第1组粘连的女性术后干预次数较少（分别为P = 0.0355、P = 0.0004和P = 0.0087）。
当最初成功分离的粘连位于子宫角部、宫颈峡部区域或累及大部分宫腔时，宫腔粘连复发的可能性增加。
