Oelsner G, Sivan E, Goldenberg M, Carp H, Admon D, Mashiach S
Department of Obstetrics and Gynaecology, Chaim Sheba Medical Centre, Tel Hashomer, Israel.
Hum Reprod. 1994 Dec;9(12):2339-41. doi: 10.1093/oxfordjournals.humrep.a138448.
This study was undertaken to report the results of microsurgical lysis of peri-adnexal adhesions and identify the patients who should be offered surgery and those who should be treated by in-vitro fertilization (IVF). In all, 19 women had filmy adhesions and 32 had dense adhesions; 68.4% of women with filmy adhesions conceived compared with 34.4% of women with dense adhesions (P = 0.02). In patients with filmy adhesions, the cumulative pregnancy rate 2 years after operation (47%) is similar to that reported after five cycles of IVF (52%), leading us to conclude that such patients should be offered surgery first. Dense adhesions are best treated by IVF. Lysis of filmy adhesions produces a similar intra-uterine pregnancy rate whether performed by laparotomy (57.9%) or laparoscopy (56.6%). As operative laparoscopy offers the greatest patient comfort, it is the treatment of choice in these patients.
本研究旨在报告附件周围粘连显微外科松解术的结果，并确定哪些患者应接受手术治疗，哪些患者应接受体外受精（IVF）治疗。共有19名女性有薄膜状粘连，32名有致密粘连；有薄膜状粘连的女性中68.4%怀孕，而有致密粘连的女性中这一比例为34.4%（P = 0.02）。在有薄膜状粘连的患者中，术后2年的累积妊娠率（47%）与IVF五个周期后的报告率（52%）相似，这使我们得出结论，此类患者应首先接受手术治疗。致密粘连最好通过IVF治疗。无论通过开腹手术（57.9%）还是腹腔镜手术（56.6%）进行薄膜状粘连松解术，子宫内妊娠率相似。由于手术腹腔镜检查给患者带来的舒适度最高，因此它是这些患者的首选治疗方法。
