Observational Study Of A New Treatment Proposal For Severe Intrauterine Adhesions.

Objective:This study was performed to present the experience with intrauterine adhesiolysis under observational study of a new treatment proposal for severe intrauterine adhesions to prevent the reformation of adhesions and its comparison with the review articles.Methods:Sixty patients of intrauterine adhesions stageⅢwith amenorrhea/hypomenorrhea were selected according to the American Fertility Society (AFS) classification of intrauterine adhesions,1988. Hysteroscopy adhesiolysis with intrauterine application of Foleys catheter, HA gel and intrauterine device of an uterine shape were done in the Department of Gynaecology of the 3rd Xiang-ya Hospital of Central South University, China. The adhesions were divided hysteroscopically by using scissors or electrode needle under direct vision. Hysteroscopy following-up/ adhesiolysis was performed one month after initial hysteroscopy surgery. Second reassessment hysteroscopy was performed usually after 2 months. Some patients underwent five reassessment of hysteroscopy, among them 54 patients had second hysteroscopy procedures,34 patients had third hysteroscopy procedures,17 patients had fourth hysteroscopy procedures and 11 patients had fifth hysteroscopy procedures. One patient did not continue her follow-up treatment after second hysteroscopy procedure. The adhesions scores were calculated for each patient and for 3 months after surgery and its comparison with hysteroscopy adhesiolysis 3 months after initial surgery of review articles. Results:Sixty patients showed a significant decrease in intrauterine adhesions at 1-month follow-up after initial hysteroscopy. Staging of adhesions shows a significant decrease in adhesion severity in patients treat with Foleys catheter, hyaluronic acid (HA) gel and intrauterine device of an uterine shape (IUD). Out of sixty patients, one patient did not continue her follow-up after second reassessment of hysteroscopy.After fifth hysteroscopic procedures of adhesiolysis, one was mild adhesions, two were moderate adhesions, and fifty-six patients were normal uterine cavity:besides the initial surgery,5 patients had one procedure,20 patients had two procedures, and 31 patients had more than two procedures.Conclusion:In this study, we have analyzed the hysteroscopy adhesiolysis in 60 patients with severe intrauterine adhesions with amenorrhea/hypomenorrhea, 1-month follow-up after initial hysteroscopy surgery a significantly reduced the reformation of intrauterine adhesions postoperatively and its use is likely to be associated with a reduction of severe adhesions. Hysteroscopy is of great value in decreasing the grade of intrauterine adhesions after operative hysteroscopy with out increasing the risk of pelvic infection.