Karande V, Levrant S, Hoxsey R, Rinehart J, Gleicher N
Division of GynecoRadiology, Center for Human Reproduction, Illinois, Chicago 60610, USA.
Fertil Steril. 1997 Oct;68(4):658-62. doi: 10.1016/s0015-0282(97)00316-6.
To present further experience with in-office lysis of intrauterine adhesions under fluoroscopic control using a specially designed catheter.
Prospective study.
Medical school-affiliated infertility center.
PATIENT(S): Seventeen infertile patients undergoing routine gynecoradiologic investigation as part of an initial infertility workup.
INTERVENTION(S): The initial hysterosalpinography was performed with a commercially available uterine catheter that seals off the uterine cavity before injection of contrast. If intrauterine adhesions were diagnosed, an immediate attempt at lysis was made using the catheter's balloon tip or hysteroscopic scissors, which were inserted through the main port of the catheter. The procedures were carried out using a paracervical block or IV analgesia.
MAIN OUTCOME MEASURE(S): Normal uterine cavity after lysis of intrauterine adhesions.
RESULT(S): Seventeen patients underwent lysis of intrauterine adhesions. In 13 patients (9 mild, 3 moderate, and 1 severe), the adhesions were lysed successfully (81.2%). Among those, nine procedures were performed with the balloon and four with scissors. In 4 cases (2 moderate and 2 severe), lysis of adhesions was only partially successful. These procedures had to be abandoned prematurely because of patient discomfort before attempting the use of scissors (n = 1), extravasation of dye into the myometrium making visualization difficult (n = 1), and thick, fibrotic adhesions that were resistant to scissors (n = 2).
CONCLUSION(S): In-office lysis of intrauterine adhesions under gynecoradiologic control can be carried out safely in the majority of patients, using minimally invasive techniques. The potential cost savings in comparison with endoscopic procedures, which require utilization of expensive operating room time, are especially relevant in today's cost-conscious managed care environment. Only failures of in-office procedures would reach the operating room under the algorithm proposed here.
介绍使用一种特殊设计的导管在透视控制下进行门诊宫腔粘连松解术的更多经验。
前瞻性研究。
医学院附属不孕不育中心。
17例不孕患者，作为初步不孕检查的一部分，正在接受常规妇科放射学检查。
初始子宫输卵管造影使用市售子宫导管，在注入造影剂前封闭子宫腔。如果诊断出宫腔粘连，立即尝试使用导管的球囊尖端或宫腔镜剪刀进行松解，这些器械通过导管的主端口插入。手术采用宫颈旁阻滞或静脉镇痛。
宫腔粘连松解术后子宫腔正常。
17例患者接受了宫腔粘连松解术。13例患者（9例轻度、3例中度和1例重度）粘连成功松解（81.2%）。其中，9例手术使用球囊，4例使用剪刀。4例患者（2例中度和2例重度）粘连松解仅部分成功。由于患者不适（n = 1）、染料外渗至肌层导致视野不清（n = 1）以及粘连致密纤维化难以用剪刀松解（n = 2），这些手术不得不提前放弃。
在妇科放射学控制下，大多数患者可使用微创技术安全地进行门诊宫腔粘连松解术。与需要占用昂贵手术室时间的内镜手术相比，潜在的成本节约在当今注重成本的管理式医疗环境中尤为重要。按照本文提出的方案，只有门诊手术失败的患者才会进入手术室。
