Department of Obstetrics and Gynaecology Gynescope Specialist Hospital, Nigeria.
Department of Obstetrics and Gynaecology Ahmadu Bello University, Zaria, Nigeria.
Afr J Reprod Health. 2022 Dec;26(12):90-96. doi: 10.29063/ajrh2022/v26i12.10.
Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352-4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.
宫腔粘连（IUA）较为罕见。本研究为回顾性对照研究，纳入了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间因开腹子宫肌瘤剔除术后发生 IUA 的 117 例患者（A 组），以及因终止妊娠（TOP）或自然流产后行子宫器械操作导致子宫创伤后发生 IUA 的 113 例患者（B 组）。采用 March 分类系统比较两组患者的 IUA 分级、妊娠率及妊娠结局。所有患者均接受了宫腔镜粘连松解术。A 组中粘连更为严重（45/117，38.5%）的患者比例高于 B 组（29/113，25.7%），但差异无统计学意义（卡方检验，5.047；p =.080）。末次宫腔镜检查后随访 24 个月。A 组的妊娠率（26/117，22.2%）显著低于 B 组（46/113，40.7%）（OR：2.403，95%CI：1.352-4.271；p =.003）。在本研究中，开腹子宫肌瘤剔除术是导致 IUA 的更主要病因。对于行开腹子宫肌瘤剔除术后有生育要求的患者，尤其是当子宫内膜腔受损时，建议术后行宫腔镜检查以排除 IUA。
