中重度宫腔粘连综合治疗效果

Abstract
Figure/Table
References
Related Citation (9)

Download: PDF (725 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To introduce an integrated therapy for women with moderate and severe intrauterine adhesion (IUA) and evaluate its reproductive outcome.Methods Seventy-five patients with IUA who had expected fertility and received an integrated therapy were retrospectively studied. The correlation of menstrual pattern, adhesion degree and adhesion reformation with the conception rate were analyzed.Results The mean age of these patients was (32.1±5.1) years old. The improvement rate of menstrual pattern was 78.7 %. The overall conception rate was 61.3 %. The conception rate was 76.6% for those with moderate IUA and 35.7% for severe cases of IUA (P<0.05). Logistic regression analysis showed that the preoperative adhesion degree and postoperative menstrual pattern were independent risk factors for pregnancy. The adhesion reformation rates during the second and third hysteroscopy were both 50%. There was significant difference in the adhesion reformation rate between moderate and severe cases of intrauterine adhesion(P<0.05). There were three (2.7%) cases of TURP syndrome during operation, which were quickly discovered and rescued.Conclusions The adhesion degree and menstrual pattern are independent risk factors for pregnancy, This integrated therapy can ensure better clinical effect for moderate and severe IUA patients, especially in restoring menstrual function and fertility.

Key words： intrauterine adhesion asherman’s syndrome hysteroscopy adhesiolysis

Received: 30 March 2016

ZTFLH:

R713.4

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	ZHANG Luping
	ZHAO Weihong
	YANG Baojun
	XU Yun
	LI Wenjun
	and FENG Limin

Cite this article:

ZHANG Luping,ZHAO Weihong,YANG Baojun等. Clinical results of integrated therapy for moderate and severe intrauterine adhesion[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2017, 28(3): 247-250.

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2017/V28/I3/247

[1]	Asherman J G. Traumatic intrauterine adhesions[J]. J Obstet Gynaecol Br Emp, 1950, 57: 892-896.
[2]	March C M. Management of Asherman’s syndrome[J]. Reprod Biomed Online, 2011, 23(1): 63-76.
[3]	The american fertility society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions[J]. Fertil Steril, 1988, 49(6): 944-955.
[4]	夏恩兰.妇科内镜学[M].北京:人民卫生出版社,2001:62.
[5]	彭雪冰,夏恩兰.羊膜宫腔内植入+人工周期治疗中、重度宫腔粘连的安全性及有效性[J].生殖与避孕,2012,32(12):857-861.
[6]	Kodaman P H, Arici A. Intra-uterine adhesions and fertility outcome: how to optimize success? [J]. Curr Opin Obstet Gynecol, 2007, 19(3):207-214.
[7]	Magos A. Hysteroscopic treatment of Asherman’s syndrome[J]. Reprod Biomed Online, 2002,3:46-51.
[8]	Deans R, Abbott J. Review of intrauterine adhesions [J]. J Minim Invasive Gynecol, 2010,17(5):555-569.
[9]	Zhang L,Xiong W,Xiong Y,et al.17 β-Estradiol promotes vascular endothelial growth factor expression via the Wnt/β-catenin pathway during the pathogenesis of endometriosis[J]. Mol Hum Reprod,2016,22(7):526-535.
[10]	Mei J,Zhu X Y,Jin L P,et al. Estrogen promotes the survival of human secretory phase endometrial stromal cells via CXCL12/CXCR4 up-regulation-mediated autophagy inhibition[J]. Hum Reprod,2015, 30(7):1677-1689.
[11]	Nayak N R, Brenner R M. Vascular proliferation and vascular endothelial growth factor expression in the rhesus macaque endometrium[J]. J Clin Endocrinol Metab, 2002, 87(4):1845-1855.
[12]	Myers E M, Hurst B S. Comprehensive management of severe Asherman syndrome[J]. Fertil Steril, 2012, 97(1):160-164.
[13]	Haapsamo M,Martikainen H, Rsnen J. Low-dose aspirin and uterine haemodynamics on the day of embryo transfer in women undergoing IVF/ICSI: a randomized, placebo-controlled, double-blind study[J]. Hum Reprod,2009, 24(4):861-866.
[14]	Lebovitz O,Orvieto R. Treating patients with "thin" endometrium - an ongoing challenge[J]. Gynecol Endocrinol, 2014,30(6):409-414.
[15]	Cicek N, Eryilmaz O G, Sarikaya E, et al.Vitamin E effect on controlled ovarian stimulation of unexplained infertile women[J].J Assist Reprod Genet, 2012, 29(4):325-328.
[16]	Atilgan R, Kuloglu T, Ozkan Z S, et al. Evaluation of vitamin C and vitamin E for prevention of postoperative adhesion: a rat uterine horn model study[J]. J Obstet Gynaecol Res, 2015, 41(3):418-423.
[17]	郭佳,李东,刘承,等.补肾养血活血中药对超促排卵周期干预作用的随机对照研究[J].中国中西医结合杂志,2013,33(4):484-487.
[18]	Preutthipan S, Linasmita V. Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital[J]. J Med Assoc Thai, 2000, 83(1):42-46.
[19]	Yu D, Li T C, Xia E, et al. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome[J]. Fertil Steril, 2008, 89(3):715-722.
[20]	AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report: practice guidelines for management of intrauterine synechiae[J]. J Minim Invasive Gynecol, 2010, 17(1):1-7.
[21]	Yang J H, Chen M J, Wu M Y, et al. Office hysteroscopic early lysis of intrauterine adhesion after transcervical resection of multiple apposing submucous myomas[J]. Fertil Steril, 2008,89(5):1254-1259.
[22]	Robinson J K, Colimon L M, Isaacson K B. Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman’s syndrome)[J]. Fertil Steril, 2008, 90(2):409-414.
[23]	Tsui K H,Lin L T,Cheng J T,et al. Comprehensive treatment for infertile women with severe Asherman syndrome[J]. Taiwan J Obstet Gynecol,2014, 53(3):372-375.