Bowman M C, Li T C, Cooke I D
University Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield, UK.
Hum Reprod. 1995 Jan;10(1):155-60. doi: 10.1093/humrep/10.1.155.
A total of 25 women undergoing videolaparoscopy and a dye test to investigate pelvic adhesions and infertility were evaluated to determine whether applying a score system to pelvic adhesions was reproducible, and its place in determining prognosis or management. The surgeon performing the laparoscopies scored each case using the American Fertility Society (AFS) system, gave an estimate of the likely prognosis from microsurgery and recorded a recommended management [surgery or in-vitro fertilization (IVF)]. The video images and histories were independently reviewed by two other surgeons experienced in tubal surgery, who also scored each case and recorded prognosis from surgery and recommended management. Several differences in adhesion scores for each case were noted. Agreement was present between surgeons regarding estimated prognosis for microsurgery and also in recommending management, particularly when prognosis was considered poor and IVF was recommended. Despite some reproducibility, the AFS score system did not predict outcome or management decisions. However, the surgeons' fundamental impression of the state of the pelvis and recommendation for either surgery or IVF were more consistent and reproducible. Any future proposed system for adhesion classification will need to account for, and be predictive of, the decreasing number of patients for whom surgery (rather than IVF) is the preferred management.
共有25名接受视频腹腔镜检查和染料试验以调查盆腔粘连和不孕症的女性接受了评估，以确定对盆腔粘连应用评分系统是否具有可重复性，以及其在确定预后或治疗方法方面的作用。进行腹腔镜检查的外科医生使用美国生育协会（AFS）系统对每个病例进行评分，对显微手术的可能预后进行估计，并记录推荐的治疗方法[手术或体外受精（IVF）]。另外两名输卵管手术经验丰富的外科医生独立审查了视频图像和病史，他们也对每个病例进行评分，并记录手术预后和推荐的治疗方法。注意到每个病例的粘连评分存在一些差异。外科医生在显微手术的估计预后以及推荐治疗方法方面意见一致，特别是当预后被认为较差且推荐IVF时。尽管有一定的可重复性，但AFS评分系统并不能预测结果或治疗决策。然而，外科医生对盆腔状况的基本印象以及对手术或IVF的推荐更为一致且具有可重复性。未来任何提议的粘连分类系统都需要考虑到，并能够预测，选择手术（而非IVF）作为首选治疗方法的患者数量在减少。
