子宫动脉栓塞后宫腔粘连生殖预后分析——附26例报告

Analysis of the Reproductive Outcome of Intra-uterine Adhesiolysis for Asherman′s Syndrome Following UAE——a Report of 26 Cases

目的:探讨子宫动脉栓塞(uterine artery embolization,UAE)后宫腔粘连患者的生殖预后。方法:2008年5月—2014年3月首都医科大学附属复兴医院宫腔镜中心行宫腔镜下宫腔粘连分离术治疗UAE后患者26例,分析宫腔粘连分离术后美国生育学会(American Fertility Society,AFS)评分、月经恢复情况以及生殖预后。结果:仅38.5%(10/26)的患者术后月经较术前有改善;88.5%(23/26)的患者术后AFS评分较术前降低;26例患者中有2例自然妊娠,妊娠率7.7%,其中1例最终以妊娠早期胚胎停育而终止妊娠,另1例目前妊娠早期先兆流产,无1例活产。结论:UAE术后宫腔粘连的患者宫腔粘连分离术后生殖预后差,其原因可能与UAE后子宫血管灌注不良影响术后内膜再生有关。

Objective：To evaluate the reproductive outcome of hysteroscopic adhesiolysis in women who had Asherman′s syndrome following uterine artery embolization （UAE）. Methods：Hysteroscopic adhesiolysis （HA） was performed in 26 women with Asherman′s syndrome following UAE from May 2008 to March 2014. The changes in AFS score and menstrual pattern and reproductive outcome were analysed. Results：38.5%of women experienced improvement in menstruation defined as subjective increase in menstrual flow after surgery. The reduction of AFS score after HA was 88.5%. The spontaneous conception rate was 7.7%（2/26）, one of which experienced miscarriage in the first trimester. Another present symptom of threatened abortion at the last following up. Conclusions：The poorer outcome of hysteroscopic adhesiolysis in women with Asherman′s syndrome following UAE may be a consequence of compromised vascular supply to the endometrium adversely affecting regeneration after surgery.