Observation In Clinical Effects Of Different Intervention Schemes After Electrotomy Of Intrauterine Adhesion

Objective To observe the clinical effects of different intervention methods after transcervical resection of intrauterine adhesion in patients with moderate to severe intrauterine adhesion.Methods Patients with moderate and severe intrauterine adhesions（128 cases of moderate adhesions and 61 cases of severe adhesions）admitted to the Department of Gynecology,Changzhou Second People’s Hospital affiliated to Nanjing Medical University from January 2016 to June 2020 were selected as the research subjects,all of them accepted electrosurgical treatment of intrauterine adhesion.According to the method of preventing readhesion after operation,they were divided into gel group（self-crosslinked sodium hyaluronate gel regimen）,balloon group（Foley balloon regimen）and combination group（self-crosslinked sodium hyaluronate gel regimen combined with Foley balloon regimen）.The recurrence conditions of postoperative adhesion and changes of menstrual pattern were observed and compared among the three groups,and the pregnancy outcomes and obstetric complications of the patients with fertility requirements were followed up.The degree of intrauterine adhesion,the number of intrauterine operations,menstrual pattern and age on pregnancy outcome were analyzed and discussed.Results The incidence of postoperative re-adhesion in the combination group was lower than that in the gel group and the balloon group（P<0.05）.There were no statistical significances in the change of menstrual pattern and pregnancy rate among the three groups（P>0.05）.In the patients with fertility requirements,the natural pregnancy rate was 62.5%（50/80）and the live birth rate was 76.00%（38/50）.Obstetric complications: 3 premature births,10 threatened abortions,7 placental adhesions,3placenta previa,3 postpartum hemorrhage,and 2 blood transfusions.Logistic regression analysis showed that the degree of preoperative intrauterine adhesion and postoperative menstrual pattern were independent influencing factors of pregnancy outcome in patients with moderate and severe intrauterine adhesion.Conclusion 1.Self-crosslinking sodium hyaluronate gel combined with Foley balloon has better efficacy than selfcrosslinking sodium hyaluronate gel or Foley balloon alone in preventing intrauterine readhesion.2.The recovery of patients with severe adhesions is relatively poor.The preoperative degree of intrauterine adhesions and postoperative menstrual patterns will affect the pregnancy outcomes of patients with intrauterine adhesions.