Cai Huihua, Qiao Lin, Song KaiJing, He Yuanli
Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Department of Obstetrics and Gynecology, General Hospital of PLA Guangzhou Military Area, Guangzhou, Guangdong, China.
J Minim Invasive Gynecol. 2017 Jan 1;24(1):80-88. doi: 10.1016/j.jmig.2016.09.021. Epub 2016 Oct 11.
To compare the efficacy of an oxidized, regenerated cellulose adhesion barrier (Interceed; Ethicon, Somerville, NJ) combined with an intrauterine device (IUD) versus an IUD alone for preventing adhesion recurrence following hysteroscopic adhesiolysis for moderate to severe intrauterine adhesions (IUAs).
Retrospective case series (Canadian Task Force classification III).
Tertiary care teaching hospital.
Patients undergoing treatment for moderate to severe IUAs. The severity of IUA was determined based on the American Fertility Society scoring system (mild, moderate, or severe).
All cases of hysteroscopic adhesiolysis were reviewed.
Seventy-six women with moderate to severe IUAs treated between March 2009 and August 2015 were included. After hysteroscopic adhesiolysis, 35 patients were treated with an IUD alone (group 1), and 41 patients were treated with Interceed plus an IUD (group 2). A second hysteroscopy was performed in all cases three months after the initial hysteroscopy and both groups achieved significant reduction in adhesion scores and grade, especially in group 2 (scores, p < .001; grade, p = .039). Compared with group 1, menstruation dysfunction, pregnancy rate, and live birth rate in group 2 improved with no statistical difference (menstruation improvement, p = .764; pregnancy rate, p = .310; live birth rate, p = .068). However, an adhesion-free uterine cavity was regained significantly owing to the fewer operations in group 2 compared with group 1 (median, 3 vs 4; p = .001). The interval from initial hysteroscopy to conception was significantly shorter in group 2 (median, 12 months vs 51 months; p < .001).
For moderate to severe IUAs, Interceed combined with an IUD may be an alternative approach for reducing adhesion recurrence after hysteroscopic adhesiolysis.
比较氧化再生纤维素粘连屏障（Interceed；美国新泽西州萨默维尔市的Ethicon公司生产）联合宫内节育器（IUD）与单纯使用IUD预防中重度宫腔粘连（IUAs）宫腔镜粘连松解术后粘连复发的疗效。
回顾性病例系列研究（加拿大工作组分类III级）。
三级护理教学医院。
接受中重度IUAs治疗的患者。IUA的严重程度根据美国生育协会评分系统（轻度、中度或重度）确定。
对所有宫腔镜粘连松解术病例进行回顾。
纳入2009年3月至2015年8月间接受治疗的76例中重度IUAs女性患者。宫腔镜粘连松解术后，35例患者单纯使用IUD治疗（第1组），41例患者使用Interceed联合IUD治疗（第2组）。所有病例在初次宫腔镜检查3个月后均进行了第二次宫腔镜检查，两组的粘连评分和分级均显著降低，尤其是第2组（评分，p <.001；分级，p =.039）。与第1组相比，第2组的月经功能障碍、妊娠率和活产率有所改善，但无统计学差异（月经改善，p =.764；妊娠率，p =.310；活产率，p =.068）。然而，与第1组相比，第2组因手术次数较少，显著恢复了无粘连的子宫腔（中位数，3次对4次；p =.001）。第2组从初次宫腔镜检查到受孕的间隔时间显著缩短（中位数，12个月对51个月；p <.001）。
对于中重度IUAs，Interceed联合IUD可能是减少宫腔镜粘连松解术后粘连复发的一种替代方法。
