早期宫腔镜检查在预防流产后宫腔粘连中的疗效：一项随机对照试验。
The efficacy of early office hysteroscopy in preventing intrauterine adhesions after abortion: a randomized controlled trial.
机构信息
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 123 Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.
出版信息
BMC Womens Health. 2024 Jul 13;24(1):400. doi: 10.1186/s12905-024-03247-0.
BACKGROUND
Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA.
METHODS
A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy.
RESULTS
The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates.
CONCLUSIONS
Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences.
TRIAL REGISTRATION
ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .
背景
宫腔粘连（IUA）是生殖不孕领域极具挑战性的临床问题。最常见的病因是宫腔内手术和流产。本研究旨在探讨早期二次宫腔镜检查是否能预防 IUA。
方法
采用单中心、前瞻性、双臂、随机对照试验设计，旨在探索早孕吸宫术后（吸引扩宫刮宫术[D&C]）早期行宫腔镜检查的疗效，并进一步分析生育结局。招募年龄 20-45 岁、因流产而行吸宫 D&C 且有生育要求的患者。研究于 2019 年 10 月至 2022 年 9 月入组 66 例患者，其中 33 例患者被分配至 A 组（早期宫腔镜干预）。干预组 A 患者计划接受 2 次宫腔镜检查（早期和晚期）。B 组仅在吸宫 D&C 后 6 个月行晚期（宫腔镜检查）。
结果
主要结局是人工流产后 6 个月行宫腔镜检查评估的 IUA 发生率。次要结局包括月经血量/持续时间和生育结局。干预组 A 中，31 例患者接受了第一次宫腔镜检查，其中 15 例完成了第二次检查。B 组（晚期宫腔镜干预，33 例）中，16 例在人工流产后 6 个月完成了宫腔镜检查。由于怀孕，21 例患者未接受晚期宫腔镜检查。A 组第一次宫腔镜检查时 IUA 发生率为 16.1%（5/31），晚期宫腔镜检查时未见 IUA。两组随访妊娠率和活产率均无统计学差异。
结论
吸宫 D&C 后行早期宫腔镜检查可发现宫腔内病变。宫腔镜早期发现的 IUA 在晚期检查时可能会消失，对未来妊娠无影响。值得注意的是，早期宫腔镜组的妊娠结局呈良好趋势，但无统计学差异。
试验注册
ClinicalTrials.gov，ID：NCT04166500。注册于 2019-11-10。https://clinicaltrials.gov/ct2/show/NCT04166500。
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