Hysteroscopic adhesiolysis and fertility outcomes of intrauterine adhesions due to endometrial tuberculosis  

子宫内膜结核所致宫腔粘连的宫腔镜下粘连松解术治疗及生育结局

作　　者：JIANG Jianfa XU Dabao YANG Yimin 蒋建发;徐大宝;杨益民(中南大学湘雅三医院妇科,长沙410013)

机构地区：[1]Department of Gynecology,Third Xiangya Hospital,Central South University,Changsha 410013,China

出　　处：《中南大学学报(医学版)》2025年第1期52-60,共9页Journal of Central South University :Medical Science

基　　金：supported by the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hosipital of Central South University,China(YX202112).

摘　　要：Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by po目的:子宫内膜结核常见于育龄期女性,是引起宫腔粘连(intrauterine adhesions,IUA)的重要原因之一,可导致月经稀发或闭经及不孕。宫腔镜下粘连松解术是治疗IUA的主要方法。然而,目前关于宫腔镜手术治疗结核所致宫腔粘连的研究极少。本研究旨在探讨宫腔镜下粘连分离术治疗子宫内膜结核所致宫腔粘连的效果。方法:本研究为回顾性队列研究。收集2014年5月至2022年10月在中南大学湘雅三医院行宫腔镜下粘连分离术的子宫内膜结核所致IUA患者的临床资料。对患者的年龄、病史、粘连程度、手术治疗情况及生育结局进行分析。结果:在收集的39例患者中,2例失访,37例纳入研究,随访时间6个月~9年。24例(64.9%)女性表现为月经过少,10例(27.0%)为继发闭经,3例(8.1%)月经正常。大部分(59.5%)患者为原发性不孕,仅有2例(5.4%)患者为继发性不孕。初始美国生育协会(American Fertility Society,AFS)评分中位数为10(范围8~12),21.6%(8/37)的患者为中度IUA,78.4%(29/37)的患者为重度IUA。37例患者共行86次手术,27例患者行2次及以上手术。25例(67.6%)患者宫腔恢复正常,12例(32.4%)患者末次手术时宫腔缩小。然而,只有7例患者在手术结束时子宫内膜大致正常(18.9%),这些患者在第1次手术时宫腔镜下显示为中度粘连。仅有12例(32.4%)患者月经恢复正常,25例(67.6%)患者月经过少持续存在。29例患者尝试体外受精-胚胎移植。仅6例(20.7%)妊娠,其中4例(13.8%)足月分娩,行剖宫产术,1例合并宫缩乏力性产后出血,1例合并胎盘粘连。结论:子宫内膜结核可导致严重的宫腔粘连。宫腔镜下宫腔粘连松解术有助于恢复宫腔,改善月经情况。但整体而言,术后生育结局并不理想。

关 键 词：endometrial tuberculosis hysteroscopic adhesiolysis intrauterine adhesions reproductive outcomes INFERTILITY 

分 类 号：R711.3[医药卫生—妇产科学]