Hysteroscopic Management of Residual Trophoblastic Tissue Is Superior to Ultrasound-Guided Curettage

作者：Rein Daniel T^*; Schmidt Torsten; Hess Alexandra P; Volkmer Anne; Schoendorf Thomas; Breidenbach Martina

来源：Journal of Minimally Invasive Gynecology, 2011, 18(6): 774-778.

DOI：10.1016/j.jmig.2011.08.003

• Residual trophoblastic tissue
• Operative hysteroscopy
• Intrauterine adhesions

Study Objective: The aim of this study was to estimate the rate of intrauterine adhesions and subsequent pregnancy outcome in patients with residual trophoblastic tissue treated with hysteroscopic resection versus ultrasound-guided dilation and evacuation (D&E).
Design: Cohort study from 2 centers (Canadian Task Force classification II-2).
Setting: Two surgical teams at the University of Duesseldorf Medical Center and the PAN Clinic in Cologne, Germany.
Patients: Women with residual trophoblastic tissue after first- or second-trimester miscarriage or term delivery.
Intervention: Two techniques were used for the removal of residual trophoblastic tissue: ultrasound-guided evacuation with a curette (D&E) and hysteroscopic resection of trophoblastic tissue (HR).
Measurements and Main Results: We evaluated 95 patients who underwent secondary intervention for residual trophoblastic disease. A total of 42 patients underwent dilation of the cervix and ultrasound-guided curettage. In a second series of 53 patients, a resectoscope fitted with a 4-mm cutting loop was used for the removal of residual trophoblastic tissue used without application of current. Three months after the intervention, second-look office hysteroscopy was performed. Differences between both treatment groups were statistically significant. After HR, mild intrauterine adhesions were found in 2 patients (4.2%). After D&E, 12 patients (30.8%) presented with intrauterine adhesions (mild intrauterine adhesions: n = 7 [17.9%]; single dense adhesions: n = 3 [7.7%]; and extensive endometrial fibrosis n = 1 [2.6%]). Eighty-two patients wanted to become pregnant. Conception rate of all patients examined was 68.8% (HR) and 59.9% (D&E) (p < .05). In patients younger than 35 years of age who underwent HR, the pregnancy rate was significantly (p < .05) increased compared with patients who underwent D&E (78.1% vs 66.6%). In addition, patients from the HR group demonstrated a significantly (p < .05) shorter time to conception (11.5 month vs 14.5 month).
Conclusion: The results of this study indicate that selective HR of residual trophoblastic tissue significantly reduces the incidence of intrauterine adhesions and increases pregnancy rates.

• 出版日期2011-12