Wagenaar Liselot P, van Vliet Hubertus A, Radder Celine M, Peters Louisette W, Weyers Steven, Schoot Benedictus C, Hamerlynck Tjalina W
Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
Eur J Obstet Gynecol Reprod Biol X. 2023 Sep 7;20:100230. doi: 10.1016/j.eurox.2023.100230. eCollection 2023 Dec.
To compare intrauterine adhesion (IUA) formation after hysteroscopic removal (HR) of retained products of conception (RPOC) with IUA formation after ultrasound-guided electric vacuum aspiration (EVA) and externally validate the outcomes of an RCT.
This prospective cohort study was conducted from April 2015 until June 2022 in 2 Dutch teaching hospitals and one Belgian university hospital. Women opting for EVA underwent the procedure as soon as possible. In the HR group, the therapeutic hysteroscopy was performed at least eight weeks after the end of pregnancy. Postoperatively, an office second-look hysteroscopy was offered to all patients. Women were included if they had been diagnosed with RPOC ranging from 1 to 4 cm on ultrasound and did not want to participate in the RCT. EVA was performed using a Karman cannula. Operative hysteroscopy consisted either of hysteroscopic morcellation with the TruClear™ System or the Intrauterine BIGATTI Shaver or cold loop resection with a bipolar resectoscope.
Of 178 included women, 124 were treated with HR and 28 with EVA. Outcomes of HR and EVA did not differ significantly in terms of complications (5.6 % vs 3.6 %; p = 1.00). Second-look hysteroscopy showed IUAs in 14 of 91 women (15.4 %) after HR and in 1 of 16 (6.3 %) after EVA (p = .461). Completeness of removal was significantly higher (90.1 %) after HR than after EVA (68.8 %) (p = .035). Additional operative hysteroscopy was required in 14.3 % of the HR group versus 37.5 % in the EVA group (p = .036).
In our cohort study, no significant differences in IUAs or complications were found. RPOC removal with HR was more often complete than removal with EVA, and additional therapeutic hysteroscopy was less frequently required after HR. These findings need to be correlated with those of RCTs.
The study was registered in de Dutch Trial Register (NTR4923). Date of registration 23-11-2014. Date of first enrollment 01-01-2015. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923.
比较宫腔镜下清除妊娠物残留（RPOC）后宫腔粘连（IUA）的形成情况与超声引导下电动真空吸引术（EVA）后IUA的形成情况，并对外验证一项随机对照试验（RCT）的结果。
这项前瞻性队列研究于2015年4月至2022年6月在两家荷兰教学医院和一家比利时大学医院进行。选择EVA的女性尽快接受该手术。在宫腔镜下清除组，治疗性宫腔镜检查在妊娠结束后至少8周进行。术后，为所有患者提供门诊二次宫腔镜检查。如果女性经超声诊断为RPOC大小在1至4厘米之间且不想参加RCT，则纳入研究。EVA使用卡曼套管进行。手术宫腔镜检查包括使用TruClear™系统或宫腔BIGATTI刨削器进行宫腔镜粉碎术，或使用双极电切镜进行冷环切除术。
在178名纳入的女性中，124名接受了宫腔镜下清除治疗，28名接受了EVA治疗。宫腔镜下清除和EVA在并发症方面无显著差异（5.6%对3.6%；p = 1.00）。二次宫腔镜检查显示，宫腔镜下清除术后91名女性中有14名（15.4%）出现IUA，EVA术后16名女性中有1名（6.3%）出现IUA（p = 0.461）。宫腔镜下清除术后的清除完整性（90.1%）显著高于EVA术后（68.8%）（p = 0.035）。宫腔镜下清除组14.3%的患者需要额外进行手术宫腔镜检查，而EVA组为37.5%（p = 0.036）。
在我们的队列研究中，IUA或并发症方面未发现显著差异。宫腔镜下清除RPOC比EVA更常能完全清除，且宫腔镜下清除术后较少需要额外的治疗性宫腔镜检查。这些发现需要与RCT的结果相关联。
该研究已在荷兰试验注册中心注册（NTR4923）。注册日期2014年11月23日。首次入组日期2015年1月1日。https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923 。
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