Objective To evaluate the effectiveness and safety of combination treatment with a predominance of hysteroscopic operations in the management of severe intrauterine adhesion (IUA). Methods Hysteroscopic exclusion was performed in 27 patients who were confirmed as severe fibrous IUA by hysteroscopy between April 2000 and March 2003. Results All the 27 patients underwent 58 times of hysteroscopic exclusion: once in 12 patients, twice in 7 patients, 3 times in 3 patients, 4 times in 2 patients and 5 times in 3 patients. Postoperative follow-up ranged 8～46 months (mean,27 months). Menstruation returned to normal in 65.2% of the patients (15/23), amenorrhea continued in 26.1% of the patients (6/23), and hypomenorrhea remained in 8.7% of the patients (2/23). Shape of uterus cavity returned to normal in 63.0% of the patients (17/27) and to basically normal in 33.3% of the patients (9/27). The total effective rate of the study was 96.3% (26/27) while a re-adhesion took place in 3.7% of the patients (1/27). The pregnancy rate after operation was 57.1% (4/7) and the live delivery rate 42.9% (3/7). There were no operative complications in the study. Conclusions The combination treatment with a predominance of hysteroscopic operations in the management of severe IUA is safe and effective. IUD placement and sodium hyaluronate can prevent the postoperative re-adhesion. Periodic treatment of estrogen and progestogen has some actions for repairing endometrium.