Rogé P, d'Ercole C, Cravello L, Boubli L, Blanc B
Service de Gynécologie-Obstétrique B. Hôpital de la Conception, Marseille.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(1):33-40.
This retrospective study of 102 patients with uterine synechias treated exclusively hysteroscopically included 52 (51%) low fertility patients, 44 (43%) with menstrual disorders and 6 (6%) with no other symptoms. More than three-fourth of the patients (76.5%) had a past history of trauma on a gravid uterus. Operative hysteroscopy was performed 148 times, including sections with scissors in 63 cases (42.4%), section with laser in 4 (3%), uterine collapse in 19 (13%) and electrosection in 62 (41.6%). A single endoscopic procedure was sufficient in 70 patients (68.6%) and 2, 3, 4 procedures were required in 22.6%, 3.9% and 4.9% of the patients respectively. No complications due to infection, bleeding or metabolic disorders occurred, but perforations were seen in 6 patients (5.8%) including 4 cases with complexe synechias. Mean follow-up was 24.4 months (range: 6-49 months); 10 patients were lost to follow-up. Good anatomic results were achieved in 88 patients after 1 or 2 hysteroscopic procedures (86.2%). Clinical results were less satisfactory, particularly in cases with low fertility in which another pathology was often associated (59%). We obtained good results in 75% of the patients with dysmenorrhoea. However, one or more pregnancies was achieved in 28 of the 50 patients contacted later (a total of 34 pregnancies including 10 abortions and 24 normal deliveries). A hysteroscopic procedure should be proposed as first intention treatment in all cases with synechia. In addition to diagnosis, hysteroscopy allows selective, reproducible treatment with little morbidity and conservation of the surrounding endometrium. After several unsuccessful procedures, surgery using Musset's technique can be proposed.
这项对102例仅接受宫腔镜治疗的子宫粘连患者的回顾性研究中，包括52例（51%）低生育力患者、44例（43%）月经紊乱患者和6例（6%）无其他症状的患者。超过四分之三的患者（76.5%）既往有妊娠子宫创伤史。共进行了148次手术宫腔镜检查，其中63例（42.4%）用剪刀分离，4例（3%）用激光分离，19例（13%）子宫塌陷，62例（41.6%）电切。70例患者（68.6%）单次内镜手术就足够了，分别有22.6%、3.9%和4.9%的患者需要2次、3次、4次手术。未发生感染、出血或代谢紊乱等并发症，但6例患者（5.8%）出现穿孔，其中4例为复杂性粘连。平均随访24.4个月（范围：6 - 49个月）；10例患者失访。88例患者在1或2次宫腔镜手术后获得了良好的解剖学结果（86.2%）。临床结果不太令人满意，尤其是在低生育力患者中，常伴有其他病理情况（59%）。痛经患者中75%取得了良好效果。然而，在随后联系的50例患者中，有28例实现了一次或多次妊娠（共34次妊娠，包括10次流产和24次正常分娩）。宫腔镜手术应作为所有粘连病例的首选治疗方法。除了诊断外，宫腔镜检查还能进行选择性、可重复的治疗，发病率低且能保留周围子宫内膜。经过几次手术失败后，可以考虑采用穆塞特技术进行手术。
