Efficacy of see-and-treat hysteroscopy versus traditional hysteroscopy in moderate-to-severe intrauterine adhesions

LI Qiurong; CAI Huifen; WANG Yanzhou; ZHAO Kangning; YOU Shijing; DENG Yuan; TAN Wenwei; TANG Shuai

doi:10.16016/j.2097-0927.202503079

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Efficacy of see-and-treat hysteroscopy versus traditional hysteroscopy in moderate-to-severe intrauterine adhesions

Clinical Medicine | 更新时间：2025-07-14

- Efficacy of see-and-treat hysteroscopy versus traditional hysteroscopy in moderate-to-severe intrauterine adhesions
- Journal of Army Medical University Vol. 47, Issue 13, Pages: 1494-1504(2025)
- 作者机构：
  
  陆军军医大学（第三军医大学）第一附属医院妇产科，重庆
- 作者简介：
  
  TANG Shuai， E-mail： 81423035@qq.com
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81300455)
- DOI：10.16016/j.2097-0927.202503079
  CLC： R195.4;R711.74;R713
- Received：31 March 2025，
  
  Revised：20 May 2025，
  
  Published：15 July 2025
- 稿件说明：
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李秋蓉，蔡惠芬，王延洲，等.一站式诊疗宫腔镜与传统宫腔镜治疗中重度宫腔粘连的疗效比较［J］.陆军军医大学学报，2025，47（13）：1494-1504.DOI：10.16016/j.2097-0927.202503079.

LI Q R，CAI H F，WANG Y Z，et al.Efficacy of see-and-treat hysteroscopy versus traditional hysteroscopy in moderate-to-severe intrauterine adhesions［J］.J Army Med Univ，2025，47（13）：1494-1504.DOI：10.16016/j.2097-0927.202503079.
李秋蓉，蔡惠芬，王延洲，等.一站式诊疗宫腔镜与传统宫腔镜治疗中重度宫腔粘连的疗效比较［J］.陆军军医大学学报，2025，47（13）：1494-1504.DOI：10.16016/j.2097-0927.202503079. DOI：

LI Q R，CAI H F，WANG Y Z，et al.Efficacy of see-and-treat hysteroscopy versus traditional hysteroscopy in moderate-to-severe intrauterine adhesions［J］.J Army Med Univ，2025，47（13）：1494-1504.DOI：10.16016/j.2097-0927.202503079. DOI：

摘要

目的

探讨宫腔镜宫腔粘连分离术（transcervical resection of adhesion， TCRA）后一站式模式诊疗宫腔镜与传统模式宫腔镜治疗宫腔粘连的患者的围术期结果以及术后妊娠结局情况。

方法

本研究为回顾性队列研究，以陆军军医大学第一附属医院妇产科2019年1月至2021年12月符合入组条件的485例中重度宫腔粘连患者为研究对象，按手术方式分为一站式模式组和传统模式组。一站式模式组：临床诊断（超声和症状）宫腔粘连后，直接进行宫腔镜下宫腔粘连分离手术；传统模式组：临床诊断（超声和症状）宫腔粘连后，先门诊宫腔镜检查确诊为宫腔粘连，再进行宫腔镜下宫腔粘连分离手术。收集2组患者的围术期各项指标、术后3D-TVUS检查相关特征、术后月经恢复情况、术后妊娠结局、产科相关并发症、新生儿结局。

结果

入组的485例患者中，一站式模式组277例，

传统模式组208例。一站式模式组，手术成功率89.89%；传统模式组，手术成功率92.79%，二者差异无统计学意义（

=1.234，

=0.267）；一站式模式组较传统模式组术后三维彩超子宫内膜形态、子宫形态、术后月经改善治疗效果更好（

0.001）；一站式模式组术后妊娠率58.84%，传统模式组术后妊娠率58.17% ，一站式模式组妊娠率略高，但两者差异无统计学意义（

=0.882）。在术后自然妊娠中，一站式组存在明显优势，一站式模式组术后自然妊娠率90.80%，传统模式组术后自然妊娠率81.82%（

=0.026）。一站式模式组活产率70.55%，不包括一人中孕持续妊娠中，一人晚孕持续妊娠中，传统组活产率74.38%，不包括3人晚孕妊娠中，两者差异无统计学意义（

=0.303）。产科相关并发症一站式模式组分娩住院输血0人少于传统组7人（

=0.003）；新生儿结局转儿科，一站式模式组低于传统模式组（10.43%

22.22%，

=0.021）；卫生经济学方面一站式宫腔镜组较传统宫腔镜有优势（

0.001）；疼痛评分方面一站式宫腔镜组与传统宫腔镜组差异没有统计学意义。

结论

一站式模式治疗宫腔粘连是一种安全可行且高效的诊断集治疗于一体的方法，可以最大限度减少手术损伤、节约时间和成本。

Abstract

Objective‍　‍To investigate the perioperative outcomes and postoperative pregnancy outcomes of patients with intrauterine adhesions(IUA) treated by see-and-treat hysteroscopy and traditional hysteroscopy in transcervical resection of adhesions(TCRA). Methods‍　‍A retrospective cohort study was performed on 485 patients with moderate-to-severe IUA who met the inclusion criteria and admitted in our hospital from January 2019 to December 2021. According to surgical approaches

the patients were assigned into a see-and-treat mode group and a traditional mode group. After clinical diagnosis(ultrasound and symptoms) of IUA

the patients from the former group received direct hysteroscopic adhesion separation surgery

and those of the latter group were diagnosed by outpatient hysteroscopy first and then hysteroscopic adhesion separation surgery. The perioperative indicators

postoperative three-dimensional transvaginal ultrasound(3D-TVUS) examination related characteristics

postoperative menstrual recovery

postoperative pregnancy outcomes

obstetric related complications

and neonatal outcomes were collected and compared between the 2 groups. Results‍　‍Among the enrolled 485 patien

there were 277 in the see-and-treat group and 208 in the traditional group. The success rate of surgical treatment was 89.89% in the see-and-treat group and 92.79% in the traditional group

but no statistical difference was seen between them(

Chi

-square=1.234

=0.267). 3D-TVUS examination displayed that the see-and-treat mode group obtained better improvement of endometrial morphology

uterine morphology and menstruation after operation than the traditional group(P

0.001). The postoperative pregnancy rate was slightly higher in the see-and-treat group than the traditional mode group(58.84%

58.17%

=0.882). However

the see-and-treat mode showed obvious advantage in the postoperative natural pregnancy rate

with a rate of 90.80%

obviously higher than that in the traditional mode group(81.82%

=0.026). The live birth rate was 70.55% in the see-and-treat mode group

excluding 1 case with ongoing pregnancy in the second trimester and 1 case with ongoing pregnancy in the third trimester

and the rate was 74.38% in the traditional group

excluding 3 cases with ongoing pregnancy in the third trimester

but there was no statistical difference between the 2 groups(

=0.303). In terms of obstetric-related complications

there were 0 cases of blood transfusion during delivery hospitalization in the see-and-treat group

while there were 7 cases in the traditional group(

=0.003). In neonatal outcomes

the rate of transfer to the pediatric department was 10.43% in the see-and-treat mode group and 22.22% in the traditional mode group(

=0.021). For health economics

the see-and-treat hysteroscopy group demonstrated a significant advantage over the traditional hysteroscopy group(

0.001). There was no significant difference in pain scores between the 2 groups. Conclusion‍　‍The see-and-treat approach is a safe

feasible

and highly efficient strategy for integrating

the diagnosis and treatment of IUA

enabling maximal minimization of surgical trauma while optimizing time and cost efficiency.

关键词

Keywords

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