| Objective: The intrauterine adhesions, also known as uterine adhesions and Asherman syndrome, since Heinrich Fritsch first find"post-traumatic uterine adhesions"to the now nearly 100 years. A variety of means causes endometrial basal layer damage lead to uterus wall adhesion .The main clinical manifestations were Cyclical abdominal pain, amenorrhea, dysmenorrhea, Spontaneous abortion or infertility. So far, the pathogenesis of intrauterine adhesions is not clear, the main etiology of intrauterine adhesions is trauma to basal layer of endometrium by varies of intrauterine operations, especially postpartum curettage in the first 2-4 weeks during pregnancy, intrauterine adhesions more easily aroused. It is reported that 1.7% of secondary amenorrhea and 40% of infertility patients with varying degrees of IUA; in 2003 , Nawroth reported that 379 primary infertile women perform hysteroscopy of cases found 74 cases of intrauterine adhesions; in 2004 ,Yucebilgin found 2 women of intrauterine adhesions in 115 infertile women's diagnostic hysteroscopy . Diverse clinical manifestations of the disease include amenorrhea, cyclical lower abdominal pain, dysmenorrhea ,infertility, repeated miscarriage, premature delivery, placenta accreta, placenta previa, placental residue and others adverse pregnancy outcomes. In recent years, with the development of hysteroscopic techniques and the frequent occurrence of abortion, intrauterine adhesions lead to the rate of detection and incidence increased year by year. Therefore, clinical obstetrics and gynecology physicians should to be familiar with the main etiology and pathogenesis of intrauterine adhesions ,and also should comprehensively master the diagnosis,treatment and prevention of intrauterine adhesions,our literature aims to investigate the etiology and diagnosis of intrauterine adhesions;to evaluate efficacy and safety of B-ultrasonography that monitored the surgy during hysteroscopic adhesiolysis operation and menstrual recovery after surgery and pregnancy reproductive outcomes.Methods: From January 2004 to October 2008, in the first and second affiliated hospital of Jilin University ,a total 37 cases which were diagnosed with intrauterine adhesions were retrospectively analyzed. In 37 cases of our Study Group, 91.89% due to the incidence of trauma to gravid uterus and the injury of the basal layer of endometrium. The majority are the first trimester vacuum aspiration abortion and curettage after medical abortion, accounting for 70.27 percent.Among these cases, performance of secondary amenorrhea in 19 cases (51.35%), five cases of secondary infertility (accounting for 13.51%). Also includes other causes of diagnostic curettage, Placed or removed IUD, intrauterine surgery, and other causes of intrauterine infection. In this study, 20 cases of clinical manifestations are amenorrhea, 7 cases of are dysmenorrhea, 8 cases are cyclical lower abdominal pain, 11 cases are infertility.In these 37 cases, 34 cases of intrauterine operation had the history of operation in uterine. intrauterine adhesions are associated with the operating frequency, there is statistical significance (p <0.05),â… group operation that had a history of intrauterine operation once accounted for 54.55%(6 / 11) with mild adhesion. Severe accounted for 9.09% (1 / 11)in these patients; 3 times or 3 times more intrauterine operations, intrauterine adhesions under hysteroscopic mostly performed moderate and severe adhesions, accounting for about 66.67% (8 / 12), only 16.67% of mild adhesions (2 / 12). The more the frequency of intrauterine operations, the more serious degree of intrauterine adhesions. Diagnosis of intrauterine adhesions include uterine curettage or other operating history, pelvic examination, HSG and hysteroscopy. 37Patients of intrauterine adhesions received hysteroscopic adhesiolysis under B-ultrasonography in monitoring, partly injected into the bladder with normal saline to make a good imaging. The use of different methods of adhesiolysis based on different shapes of adhesion performed under hysteroscopy. We can use the electrosurgical loop and knife-like or needle-like electrode for adhesion resection. IUDs were placed in the uterus after surgery, 3~5 days antibiotic treatment were also necessary, and oral estrogen and progesterone treatment for 3 months to promote endometrial repairment in order to prevent the recurrence of post-operative intrauterine adhesions. Three months after, a review hysteroscopic look was received, when uterus was appropriate for pregnency, removed the IUD. Patients requested a child could attempt to pregnant. Until March 2009, follow-up of all patients were performed though the telephone or letter about uterine Anatomic recovery in three months after surgery, menstrual and pregnancy outcome.Results: 37 cases of patients with B-ultrasonography to monitor the hysteroscopic adhesiolysis of intrauterine adhesions, 9 cases of mild adhesion and 15 cases of moderate adhesion patients restored normal anatomy in the uterine cavity with a total of 24 cases , showing bilateral tubal openings. 13 cases of patients with severe adhesions, 10 cases of uterine cavity returned to normal atanomy after adhesiolysis showing bilateral tubal openings, two cases of normal uterine cavity were received with one side of tubal openings was exposed, one cases of normal uterine cavity with bilateral fallopian tubes opening were not exposed. 37 cases of Patients'operation are successfully, non-occurrence of one cases of uterine perforation, infection, TURP syndrome, and other complications. For 37 cases, 32 cases follow-up were catched, 5 cases were lost, with a follow-up rate of 86.49%. The follow-up period was 1-5 years with an average of 3 years. The situation of postoperative follow-up were: (1) 3 months after the surgery, a review hysteroscopic look performed completely normal atanamy uterine cavity in 10 cases (31.25%), generally return normal intrauterine cavity in 16 cases (50.0%), to be intrauterine adhesions again 6 cases (18.75%). (2) menstrual situation: in 7 cases of dysmenorrhea, 6 cases restored normal menstruation, menstruation is still less for 1 cases; in 18 cases of amenorrhea cases: 11 cases of patients had normal menstruation, menstrual cycle, but the volume were less in 4 cases, 3 cases of patients had no menstruation; three cases of irregular menstruation returned back to normal. 85.71% patients (24/28) had improved menses, the resumption of cyclical menstruation. (3) cyclical abdominal pain: All of 8 patients who had symptoms of abdominal pain disappeared. (4) effect after surgery: 32 cases of follow-up patients healed in 10 cases (31.25%), effective in 16 cases (50.0%), the total effective rate was 81.25% (26/32); Non-functional: 6 cases (18.75%). (5) the situation of pregnancy after operation: 21 cases of postoperative patients require fertility, contraception between 3 months to 1 years, 9 cases regnanted, 7 cases had full-term birth.For Mild, moderate and severe intrauterine adhesions,rates of pregnancy in three groups were 66.67%, 37.5%, 28.57%; and rates of live birth were 50%, 37.5%, 14.29%; for the total 32 cases , rate of pregnancy was 42.86 %, full-term live birth rate was 33.33%.Conclusion: (1)Any damage factors of the basal layer of endometrium may lead to intrauterine adhesions, associate with the excessive curettage and suction operation of uterus in particular. (2)Genital tuberculosis leading to intrauterine adhesions is another important reason which performs poor prognosis. (3)The occurrence of intrauterine adhesions is related with the gravid uterine operating frequency and degree of injury of endometrium .The more the number of intra-uterine operations ,the more severe adhesions. (4)Diagnostic hysteroscopy is the gold standard of intrauterine adhesions. Hysteroscopic electrosurgery is an effective treatment method for intrauterine adhesions. 5.Hysteroscopic surgery in B- ultrasonography monitoring is safe and feasible method, B-ultrasonography can replaced the laparoscopy monitoring, be more simple, economic, less trauma and high safety. |
PDF Full Text Request