Objective is to evaluate the effectiveness of a complex method of treating patients with Asherman’s syndrome.
MATERIAL AND METHODS
The analysis of the treatment of 80 patients of reproductive age (18—36 years) with Asherman’s syndrome — intrauterine adhesion of moderate (group 1) and severe (group 2) degrees, respectively, related to stages II and III according to the classification of the American Fertility Society (AFS) ). The main stage in the complex treatment of patients was hysteroscopy with acute dissection of adhesion. «Office» (i.e. on an outpatient basis) hysteroscopy was performed in 37 (46.25%) patients, operative hysteroscopy with anesthetic aid — in 27 (33.75%), laparoscopic control — in 16 (20%). Intraoperatively, at the end of adhesion-lysis, an anti-adhesion barrier gel containing carboxymethylcellulose or its combination with hyaluronate and sodium alginate was injected into the uterine cavity in 25 patients of each group. In order to diagnose the recurrence of adhesion, 4—8 weeks after initiating surgical treatment, «office» hysteroscopy and, if necessary, repeated adhesion-lysis was performed. Hormonal therapy with estrogens and progestins was used as a method of secondary prevention.
RESULTS
The complex method of treatment with the use of anti-adhesion barriers was most effective in the moderate severity of Asherman’s syndrome — the re-formation of adhesion was noted in 12% of cases (in the control subgroup — in 33.3%). In patients with a severe degree of Asherman’s syndrome, the number of relapses after the use of adhesion barriers was 25—30.8% which did not differ significantly from the data of the control subgroup (33.3%).
CONCLUSION
The combined approach to the treatment of patients with Asherman’s syndrome is based on adequate and careful surgical intervention in combination with active postoperative management. Intraoperative introduction of anti-adhesion barriers into the uterine cavity is advisable; however, the indications for use and its frequency are set individually, depending on the morphological picture of the state of the endometrium and the severity of intrauterine adhesion.
