- 作者：Attilio Di Spiezio Sardoa ; cdispie@tin.it" class="auth_mail" title="E-mail the corresponding author ; Gloria Calagnab ; Marianna Scognamiglioa ; Peter O&rsquo ; Donovanc ; Rudi Campod ; Rudy L. De Wildee
- 关键词：Intrauterine adhesion ; Prevention ; Hysteroscopy
- 刊名：European Journal of Obstetrics & Gynecology and Reproductive Biology
- 出版年：2016
- 出版时间：August 2016
- 年：2016
- 卷：203
- 期：Complete
- 页码：182-192
- 全文大小：503 K
Study Design
A systematic computerized literature search was conducted to provide a survey of the various measures used in hysteroscopic surgery to prevent adhesions. Finally, 29 studies were included in the analysis, showing a wide variety of methods and agents advocated in international literature. They are explained in various sections, based on the IUA prevention approach adopted (surgical technique, early second-look hysteroscopy, barrier method, pharmacological therapy).
Results
The results of our review show that (i) use of surgical techniques which reduce the use of electrosurgery should be preferred whenever possible (Level of evidence: 4); (ii) an early second-look hysteroscopy would appear to be an effective preventive, as well as therapeutic, strategy regarding IUA but studies on the topic are too few for relevant evidence; (iii) barriers methods are the most widely used and, among these, gel barriers have been proven to have a significant clinical effect on IUA prevention, because of higher adhesiveness and prolonged residence time on the injured surface (Level of evidence: 1b); (iv) the role of hormonal and antibiotic therapy in the prevention of post-operative IUA is difficult to evaluate as it has been used in association with other prevention strategies in most studies included in our review.
Conclusions
Robust and high quality randomized trials to assess the effectiveness of different anti-adhesion therapies are still needed before one or more of these strategies may be strongly recommended for improving clinical outcomes in women treated by operative hysteroscopy.