Clinical Studies Of Intrauterine Adhesions Separation Prevention Of Postoperative Adhesions

Objective: Intrauterine adhesions(intrauterine adhesion, IUA) is due to uterine surgery operation or secondary infections lead to endometrial basal layer damage, leading to the uterine cavity, uterine isthmus, some or all of the cervical canal wall adhesions, also known as Asherman’s syndrome. The main clinical manifestations of menstrual flow is too small or amenorrhea, under periodic abdominal pain, secondary infertility, pregnancy habitual abortion, premature delivery, placenta accreta, placenta implantation. Hysteroscopy is the gold standard for diagnosis of intrauterine adhesions. Hysteroscopic intrauterine adhesions dissection(transcervical resection of adhesions, TCRA) is the preferred method for the separation of intrauterine adhesions, but the separation of intrauterine adhesions after surgery recur, so postoperative adhesion prevention is the key. At present, the commonly used clinical precautions: intrauterine balloon catheter placement, the IUD(intrauterine device, IUD), artificial cycles of intrauterine injection of anti-blocking agent, subcutaneous growth hormone, etc., but the lack of uniform standard, in this study recognized the combined therapy(TCRA + IUD + E2V), the addition of the inner uterine cavity after subcutaneous injection of sodium hyaluronate or growth hormone, compare the therapeutic effect of these two methods, it is desirable to find a consolidated methodologies IUA more effective treatment to restore the patient’s normal menstrual reduce recurrence IUA, improved fertility.Methods: Collected in March 2013 ~ May 2014 in Yancheng MCH treatment of secondary amenorrhea or secondary complained reduce menstrual flow by hysteroscopy diagnosed as severe intrauterine adhesions in 70 patients, surgery simultaneously TCRA surgery. According to the different treatment methods are divided into three groups: A group of 27 cases, including 18 cases of moderate adhesions, nine cases of severe adhesions; after a few months in 22 cases, 5 cases of amenorrhea, placed in the uterine surgery within TRCA- Large "Palace" shaped IUD, while giving the postoperative period of oral estrogen and progesterone therapy(estradiol valerate 6mg/d, a total of 21 d, 10 d after adding progesterone capsules 200mg/d, 3 consecutive months); Group B 24 cases, including 17 cases of moderate adhesions, seven cases of severe adhesions; after a few months in 20 cases, 4 cases of amenorrhea, TRCA uterine surgery double-lumen balloon catheter placement(14Fr the Foley catheter, cut off the tip of the catheter balloon section), balloon 3.5-5m L saline injection, since the balloon another cavity injection 3m L sodium hyaluronate injection catheter will end knotted to prevent its outflow, surgery after while giving oral estrogen and progesterone treatment cycle(estradiol valerate 6mg/d, a total of 21 d, 10 d after adding progesterone capsules 200mg/d, continuous March), three days after balloon dilation tube removed, intrauterine place- the large "Palace" shaped IUD; Group C 19 cases, including 14 cases of moderate adhesions, five cases of severe adhesions; after a few months in 16 cases, 3 cases of amenorrhea in group A, based on the addition of recombinant human growth hormone after 4u/d, subcutaneous, continuous 5d. All the patients three months after hysteroscopy again, take the ring simultaneously surgery patients, understand uterine shape, and the recovery period of follow-up.Results: 1. A group of menstruation efficiency 62.96%, after intrauterine adhesions rate 37.04%; group B 87.50% efficient recovery period, postoperative intrauterine adhesions rate 12.50%; group C menstrual recovery efficiency 89.47%, after the Palace cavity adhesions rate 10.53%.2. Group B and Group C in the recovery period, a significant difference(P<0.05) difference between efficient and intrauterine adhesions after surgery compared with A group rate.3. B, C groups in the postoperative period and recovery efficiency rate of intrauterine adhesions by chi-square test, the difference was no significant difference(X2 = 0.040, P = 0.841).Conclusions: 1. Intrauterine adhesions underwent intrauterine adhesions separation surgery, intrauterine IUD placement, combined estrogen-progestin oral artificial cycle of treatment, rehabilitation and prevention of postoperative menstrual intrauterine adhesions have a certain role.2. Joint sodium hyaluronate or growth hormone for moderate to severe intrauterine adhesions after separation, are better than recognized comprehensive treatment method(TCRA+IUD+E2V).3. TCRA+IUD+E2V combined sodium hyaluronate or growth hormone for moderate to severe intrauterine adhesions after separation, can be effective in preventing intrauterine adhesions again, increase menstrual improvement rate, both of similar effect.