Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V
Department of Obstetrics and Gynecology Kaplan Hospital Rehovot, Israel.
Int J Fertil Menopausal Stud. 1996 Sep-Oct;41(5):462-5.
To determine whether hysteroscopic adhesiolysis improves reproductive outcome in women with Asherman's syndrome and pregnancy failure.
Ninety consecutive women who had undergone hysteroscopic adhesiolysis of intrauterine adhesions during a 5-year period. Only women in whom at least two previous pregnancies had ended with either a spontaneous abortion or a premature delivery accompanied by fetal or neonatal mortality and a hysteroscopic diagnosis of intrauterine adhesions were enrolled.
Whereas pregnancy outcome prior to the operation was 18.3% term deliveries, 3.3% premature deliveries, 62.4% first-trimester abortions, and 16.0% late abortions, after hysteroscopic adhesiolysis pregnancy outcome was 68.6% term deliveries, 9.3% premature deliveries, 17.4% first-trimester abortions, and 4.7% late abortions. In women with two previous unsuccessful pregnancies, the operative success rate measured by delivering a healthy newborn improved from 18.3% preoperatively to 64% postoperatively. In women with three or more unsuccessful pregnancies the success rate improved from 18.3% to 75%. Successful outcome of adhesiolysis was observed in 61.9% of mild (stage I) and in 70.6% of moderate to severe cases (stages II and III) of intrauterine adhesions.
Hysteroscopic adhesiolysis in women with Asherman's syndrome and poor reproductive performance contributes significantly to a successful reproductive outcome.
确定宫腔镜粘连分解术能否改善患有阿谢曼综合征且有妊娠失败史女性的生殖结局。
连续90名在5年期间接受过宫腔镜子宫内粘连分解术的女性。入选标准为至少有过两次妊娠，且妊娠结局为自然流产或早产并伴有胎儿或新生儿死亡，同时经宫腔镜诊断为子宫内粘连的女性。
手术前的妊娠结局为足月分娩占18.3%，早产占3.3%，孕早期流产占62.4%，孕晚期流产占16.0%；宫腔镜粘连分解术后的妊娠结局为足月分娩占68.6%，早产占9.3%，孕早期流产占17.4%，孕晚期流产占4.7%。在有过两次妊娠失败史的女性中，以分娩出健康新生儿衡量的手术成功率从术前的18.3%提高到了术后的64%。在有三次或更多次妊娠失败史的女性中，成功率从18.3%提高到了75%。子宫内粘连轻度（I期）患者的粘连分解成功率为61.9%，中度至重度（II期和III期）患者的成功率为70.6%。
对于患有阿谢曼综合征且生殖性能不佳的女性，宫腔镜粘连分解术对成功的生殖结局有显著贡献。
