Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Department of Ultrasonography, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Medicine (Baltimore). 2022 Sep 9;101(36):e30480. doi: 10.1097/MD.0000000000030480.
To evaluate the feasibility and efficiency of our novel technique, ultrasound guided hysteroscopic catheter dilation (US-HCD), for the treatment of moderate to severe intrauterine adhesion (IUA). A total of 126 patients diagnosed with IUA and met the enrollment criteria were admitted in this historical cohort study from June 1, 2016 to December 31, 2018. All patients were divided into 2 groups according to the surgical techniques used. Group A (n = 68) were treated with traditional hysteroscopic adhesiolysis with scissors (THA) and Group B (n = 58) were treated with US-HCD. Their data for the next 2 years following the initial surgery were analyzed. Safety and feasibility (operation time, surgical complications and the third-look hysteroscopic surgery rate), and post-operation efficacy (reduction of American Fertility Society [AFS] scores, pregnancy and live birth rates) were evaluated between groups. Between the groups, there was no statistically significant differences in basic preoperative information and AFS scores (P > .05). While there were significant differences in the operation time of the initial surgery (P < .05) and reduction of AFS scores (P < .05). No surgical complications were recorded and only 3 patients (5.2%) received a third-look hysteroscopy in Group B, while there were 6 cases of complications and 13 cases (19.1%) of third-look hysteroscopy in Group A, indicating significant differences between Groups (P < .05). Both groups exhibited comparable pregnancy rate, live birth rate and obstetric complications (P > .05). Our new technique is a safe, feasible and effective procedure for moderate to severe IUA patients, which can be mastered more quickly and easily by surgeons and applied in areas with less affluent economy and without hysteroscopic scissors, thus worthy of further study.
为了评估我们新的技术——超声引导宫腔镜导管扩张术（US-HCD）治疗中重度宫腔粘连（IUA）的可行性和效率，我们进行了这项历史性队列研究。共有 126 名符合 IUA 诊断且符合纳入标准的患者于 2016 年 6 月 1 日至 2018 年 12 月 31 日被纳入该研究。所有患者均根据所采用的手术技术分为 2 组。A 组（n=68）采用传统的宫腔镜剪刀粘连松解术（THA）治疗，B 组（n=58）采用 US-HCD 治疗。对所有患者在初始手术后的 2 年内的数据进行了分析。对安全性和可行性（手术时间、手术并发症和第 3 次宫腔镜手术率）以及术后疗效（美国生殖医学学会评分 [AFS]降低率、妊娠率和活产率）进行了评估。组间基本术前资料和 AFS 评分无统计学差异（P＞0.05）。然而，初始手术的手术时间（P＜0.05）和 AFS 评分降低率（P＜0.05）存在显著差异。B 组未记录到手术并发症，仅 3 例（5.2%）患者接受了第 3 次宫腔镜检查，而 A 组有 6 例并发症和 13 例（19.1%）第 3 次宫腔镜检查，组间差异有统计学意义（P＜0.05）。两组患者的妊娠率、活产率和产科并发症均无显著差异（P＞0.05）。我们的新技术是治疗中重度 IUA 患者的一种安全、可行且有效的方法，术者更容易掌握且不需要宫腔镜剪刀，适用于经济欠发达且无宫腔镜剪刀的地区，值得进一步研究。
