| Purpose:Intrauterine adhesion(IUA):refers to the intrauterine operation or miscarriage infection,puerperal infection,endometrial tuberculosis infection caused the endometrial injury,so the intrauterine adhesion tissue formation,resulting in partial or complete uterine cavity closed.Clinically cause the reduction of menstrual flow,amenorrhea,infertility,recurrent miscarriage,abdominal pain and other symptoms.IUA mechanism is still not clear,the current treatment is mainly using hysteroscopic to separate severe intrauterine adhesions,but postoperative adhesion recurrence rate is still high,preventing recurrence of postoperative adhesion is one of the important steps in the treatment of IUA and improving prognosis.This article through comparative analysis the postoperative adhesion,menstrual improvement,pregnancy rate with the different balloon combined with polylactic acid anti-adhesion gel and simple use of uterine balloon after transcervical resection of severe uterine adhesion.Materials and methods:A retrospective analysis of 88 patients with severe intrauterine adhesion who hospitalized in Dalian Maternal and Child Health Hospital with hysteroscopy treatment in January 2013 to June 2016.All patients underwent hysteroscopic intrauterine adhesion and taking estradiol valerate 2-3 months.Grouped according to postoperative prevention of adhesions:group A:Place the Foley balloon and polylactic acid anti-adhesion gel(25 cases),group B:Place the balloon capsule and polylactic acid anti-adhesion gel(32 cases),group C:Place the balloon capsule(31 cases).The general situation of preoperative,intraoperative and postoperative patients was analyzed,including age,course of disease,number of intrauterine operations,preoperative white blood cell count,adhesion site,operation time,postoperative white blood cell count,excluding their impact on the results of this study.After 7 days to remove the balloon,after 2 months to do a second hysteroscopy to understand the patient’s postoperative uterine cavity,close follow-up menstruation and pregnancy.Analysis of A,B,C three groups of patients with efficacy,re-adhesion rate,re-adhesion type,pregnancy rate.SPSS 19.0 system software was used for statistical analysis.One-way ANOVA was used to compare the number of samples.The X2 test and the four-table exact probability method were used for the comparison.P<0.05 showed that the difference was statistically significant significance.Results:① General situation before surgery:There were no significant differences in age,course of disease,intrauterine operation,preoperative white blood cell count and adhesion site between the treatment groups(P>0.05).② Intraoperative and postoperative general situation:the operation time,postoperative white blood cell count difference was not statistically significant(P>0.05).③The total effective rate was 72.0%in group A,93.8%in group B and 93.6%in group C.The total effective rate of group B and group C was significantly higher than that of group A,the difference was statistically significant(P<0.05).The total effective rate of group B was similar to that of group C,the difference was not statistically significant(P>0.05).④ A group re-adhesion rate of 56.0%,adhesion type:the central configuration ratio of 7.1%,the surrounding type composition ratio of 78.6%,mixed type composition ratio of 14.3%,B group re-adhesion rate of 28.1%,adhesive type:the central type ratio of 22.2%,the surrounding type composition ratio of 66.7%,mixed type composition ratio of 11.1%,C group re-adhesion rate of 29.0%,adhesive type:the central type of composition ratio of 22.2%,the surrounding structure ratio of 55.6%,mixed type composition ratio of 22.2%.The re-adhesion rate of group A was significantly higher than that of group B and group C,the difference was statistically significant(P<0.05),comparison of three groups of re-adhesion,the difference was not statistically significant(P>0.05)⑤Pregnancy:A group of pregnancy rate of 12.0%;B group of pregnancy rate of 21.9%;C group pregnancy rate of 19.4%.There was no significant difference in the pregnancy rate between the three groups(P>0.05).Conclusion:① Palace balloon is better than Foley balloon in prevention of uterine cavity adhesion and improvement of menstruation after separated severe intrauterine adhesion.②The use of uterine balloon at the same time placed anti-adhesion gel on the uterine cavity re-adhesion prevention and improvement of menstruation did not significantly improve.③Palace balloon and Foley balloon on the uterine horn,uterine fundus,lateral wall of the re-adhesion prevention in this study no significant difference,may be related to the smaller sample size.④In this study,three groups of prevention of re-adhesion method to improve the patient’s pregnancy rate no difference,may be related to the smaller sample size,but may also be affected by other factors.⑤ On the prevention of intrauterine adhesion there are many problems need to continue to study. |
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