Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman's syndrome).

摘要

OBJECTIVE: To evaluate postoperative blunt adhesiolysis after sharp adhesiolysis for the treatment of intrauterine adhesions. DESIGN: Retrospective analysis of 24 patients treated with primary hysteroscopic adhesiolysis followed by hormone therapy and serial flexible office hysteroscopy (Canadian Task Force Classification II-3). SETTING: University-affiliated community hospital. PATIENT(S): Twenty-four women with menstrual disorders, pain, or infertility resulting from intrauterine adhesions. INTERVENTION(S): Serial, postoperative, hysteroscopic blunt adhesiolysis of recurrent synechiae. MAIN OUTCOME MEASURE(S): Restoration of normal menstrual pattern, relief of dysmenorrhea, improvement in fertility, and improvement in stage of disease. RESULT(S): Eighty-three percent of patients (20/24) presented with amenorrhea or oligomenorrhea, 67% (16/24) had either infertility or recurrent miscarriages, and 54% (13/24) presented with dysmenorrhea. Initially, 50% (12/24) had severe adhesions, 46% (11/24) moderate, and 4% (1/24) minimal disease according to the March criteria. Improvement in menstrual flow occurred in 95% (18/19) of patients, relief of dysmenorrhea occurred in 92% (12/13), and 46% (7/15) of fertility patients were actively pregnant or had delivered viable infants at the conclusion of the study. There was a 92% (22/24) improvement in disease staging over the treatment interval. CONCLUSION(S): Blunt adhesiolysis with a flexible hysteroscope is effective for maintenance of cavity patency after primary treatment of intrauterine adhesions.