中重度宫腔粘连分离术后复查期限对宫腔形态恢复的影响

Effects of early intervention of second-look office hysteroscopy in the prevention of adhesion reformation for moderate-severe Asherman＇s syndrome

目的 评价不同宫腔镜复查期限对中重度宫腔粘连术后预后的影响.方法 选取2010年1月至2012年12月浙江大学附属邵逸夫医院因中重度宫腔粘连行宫腔镜粘连分离手术的125例进行回顾性研究.所有患者均行2次宫腔镜检查,如有粘连予以分离,直至复查恢复宫腔正常形态.根据2次宫腔镜检查距首次手术的时间间隔分为3组：A组＜1个月（50例）,B组1～2个月（39例）,C组≥2个月（36例）.结果 所有入组患者术后AFS评分均有显著性下降（P＜0.01）,恢复正常宫腔比例为64.8%（81/125）.3组AFS评分下降中位数分别为：A组7分,B组7分,C组5分,A、B组与C组比较差异有统计学意义（P＜0.01）.3组术后恢复正常宫腔比例分别为78%、66.7%及44.4%,其中A组治疗效果显著优于C组（P＜0.01）.3组恢复正常宫腔中位时间分别为1.64、2.75及5.26个月,三者比较差异有统计学意义（P＜0.01）,其中以〈1个月组所需治疗时间最短,此外A组所需手术次数显著低于C组（P＜0.01）.结论 宫腔粘连复查期限〈1个月能够显著减少宫腔粘连分离次数,缩短治疗时间.

Objective To compare the efficacy of different time interval in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate-severe Asherman＇s syndrome. Methods A total of 125 women with moderate-severe Asherman＇s syndrome undergoing hysteroscopic division of intrauterine adhesion were enrolled into this retrospective cohort study. All patients underwent second-look hysteroscopy after a certain period of the first hysteroscopie adhesiolysis, and the operation would be performed again if any adhesion existed. According to the different time interval of hysteroscopy examination, they were divided into 3 groups：A： 〈 1 month （n =50）, B：1-2 months （n =39）, C 〉2 months （n = 36）. The effect of hysteroscopic adhesiolysis was evaluated by American Fertility Society （AFS） score. Results The AFS score decreased significantly after hysteroscopic adhesiolysis in each group and the normal uterine rate was up to 64. 8%. The median of decreased AFS score and normal uterine rate were as follows：group A：7 point and 78%, group B：7 point and 66. 7% , group C：5 point and 44. 4%. And groups A and B achieved significantly （P 〈 0. 01 ） greater reductions in the adhesion score than that of group C. The median time of recovery to normal uterine cavity were l. 64, 2. 75 and 5.26 months in each group and great differences existed among them （ P 〈 0. 01 ）. Conclusion The time interval of second-look hysteroscopy less than 1 month offers a better prognosis in the prevention of adhesion reformation for moderate-severe Asherman＇s syndrome.