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陳怡仁 台北榮民總醫院婦科主治醫師. Introduction. Asherman’s symdrome occure after trauma to the basailis layer of the endomtrium generally after endometrial currettage. ( Fritsch H 1894) Granulation tissue on either side of the endometrial cavity can fuse to from tissue gridge.
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陳怡仁 台北榮民總醫院婦科主治醫師
Introduction • Asherman’s symdrome occure after trauma to the basailis layer of the endomtrium generally after endometrial currettage. ( Fritsch H 1894) • Granulation tissue on either side of the endometrial cavity can fuse to from tissue gridge. • Amenorrhea ,with or without severe dysmenorrhea, oligomenorrhea, infertility or recurrent miscarriage, hematometrial.
After hysteroscopic adhesiolysis: normal menstruation: 88.2%. • Currently treatment: sharp hysteroscopic adhesiolysis and a course of oral estrogen with subsequent P. • Question: ideal dosing regimen or length of estrogen ? • IUDs: controversy • During postoperative 2nd look office hysteropsies: a gradual progression of recurrent adhesions over time.
Materials and methods • 2003-2005, 25 women • Sharp hysteropsic adhesiolysis under GA and sonography • 5.5mm 0D rigid hysteroscopy • 25 days of conjugated estrogens (2.5mm) and 5 days of combined conjugated estrogens/MPA(2.5/10mg) • Serial postoperative office hysteroscopy :3.5mm flexible hysteroscopy to perform blunt adhesiolysis. (2-3 weeks later until minal or no disease)
Result • 95% (18/19) nomral menses after treatment (p<0.0001) • 92%(12/13) relief dysmenorrhea (p=0.0002) • 2nd look • 92%(22/24) improve in the stage • 75% (18/24) : minimal to no disease • 58% (6/12) severe disease had minimal to no disease.
