자궁내 유착에 대한 자궁경 유착박리술 후 생식능력에 영향을 미치는 요인: 수술 후 생존출산율
Factors affecting reproductive outcome of hysteroscopic adhesiolysis for intrauterine adhesion: Live-birth rate after surgery
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적본 연구의 목적은 자궁내 유착에 대한 자궁경 유착박리술 후 생존출산에 영향을 미치는 요인들을 알아보기 위해 시행되었다. 연구방법불임과 반복적 자연유산을 주소로 하는 54명의 의무기록을 후향적으로 분석하였다. 독립변수들로는 자궁내 유착의 정도, 수술방법, 자궁강내 도뇨관과 자궁내 장치의 사용여부, 수술 후 사용된 에스트라디올의 용량으로 하였으며 다변량 분석과 단변량 분석을 시행하였다. 결과54예 중 17예에서 생존 출생아가 있었다. 다변량 분석과 단변량 분석에서 자궁내 유착의 정도만이 생존출산율에 영향을 미치는 요인으로 나타났다. 수술방법에 있어 가위를 사용한 경우에 절제경보다 더 높은 생존출산율을 보였으나 통계적으로 유의한 결과는 보이지 않았다. 결론자궁내 유착의 정도가 생존출산에 영향을 미치는 가장 중요한 요인이었다. 자궁강내 도뇨관과 자궁내 장치의 사용여부, 수술 후 사용된 에스트라디올의 용량은 영향이 거의 없었다.
Abstract
Objective The purpose of this study is to assess the impact of various factors of hysteroscopic lysis of intrauterine adhesion on live-birth rate after surgery. Methods Medical records of 54 patients suffering from infertility or recurrent spontaneous abortion were retrospectively analyzed. The independent variables were degree of intrauterine adhesion, surgical technique, use of intrauterine Foley catheter, insertion of intrauterine device, and dose of postoperative estradiol. Multivariate analysis as well as univariate analysis was performed. Results Among the 54 patients, 17 patients gave live-birth. The degree of intrauterine adhesion was found to be a sole factor affecting the live-birth rate by univariate and multivariate analysis. The mechanical dissection with scissors had been resulted a higher live-birth rate against resectoscopic electrosurgery, but the difference was not statistically significant. Conclusion The degree of intrauterine adhesion is the most important factor affecting the live-birth. The uses of intrauterine Foley catheter, insertion of intrauterine device and dose of postoperative estradiol have little impact.
참고문헌 (23)
- Fritsch H, "Ein Fall von volligem Schwund der Gebormutterhohle nach Auskratzung", Zentralbl Gynaekol, 18, pp.1337~1342 (1894)
- Asherman JG, "Amenorrhoea traumatica (atretica)", J Obstet Gynaecol Br Emp, 55, pp.23~30 (1948)
- March CM, "Intrauterine adhesions", Obstet Gynecol Clin North Am, 22, pp.491~505 (1995)
- Westendorp IC, "Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion", Hum Reprod, 13, pp.3347~3350 (1998)
- March CM, "Gestational outcome following hysteroscopic lysis of adhesions", Fertil Steril, 36, pp.455~459 (1981)
- Fernandez H, "Fertility after treatment of Asherman’s syndrome stage 3 and 4", J Minim Invasive Gynecol, 13, pp.398~402 (2006)
- Pabuccu R, "Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae", Fertil Steril, 90, pp.1973~1977 (2008)
- Duffy S, "In-vivo studies of uterine electrosurgery", Br J Obstet Gynaecol, 99, pp.579~582 (1992)
- Propst AM, "Anatomic factors associated with recurrent pregnancy loss", Semin Reprod Med, 18, pp.341~350 (2000)
- Yu D, "Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman’s syndrome", Fertil Steril, 89, pp.715~722 (2008)
- March CM, "Hysteroscopic management of intrauterine adhesions", Am J Obstet Gynecol, 130, pp.653~657 (1978)
- 음현지, "자궁경을 이용한 자궁내강유착증 치료의 임상적 고찰", Obstetrics & Gynecology Science, 44(7), pp.1285~1290 (2001), 대한산부인과학회
- Kim BW, "Clinical outcome of intrauterine adhesion after resectoscopy", Korean J Obstet Gynecol, 42, pp.2242~2247 (1999)
- Thomson AJ, "Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes", Fertil Steril, 87, pp.405~410 (2007)
- Capella-Allouc S, "Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility", Hum Reprod, 14, pp.1230~1233 (1999)
- "The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions", Fertil Steril, 49, pp.944~955 (1988)
- Thomson AJ, "The management of intrauterine synechiae", Curr Opin Obstet Gynecol, 21, pp.335~341 (2009)
- Roy KK, "Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome", Arch Gynecol Obstet, 281, pp.355~361 (2010)
- Robinson JK, "Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman’s syndrome)", Fertil Steril, 90, pp.409~414 (2008)
- Orhue AA, "A comparison of two adjunctive treatments for intrauterine adhesions following lysis", Int J Gynaecol Obstet, 82, pp.49~56 (2003)
- March CM, "Asherman’s syndrome", Semin Reprod Med, 29, pp.83~94 (2011)
- Bosteels J, "The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review", Hum Reprod Update, 16, pp.1~11 (2010)
- Zikopoulos KA, "Live delivery rates in subfertile women with Asherman’s syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system", Reprod Biomed Online, 8, pp.720~725 (2004)