| Background and ObjectiveIntrauterine adhesions (IUA) refers to endometrial fibrosis and adhesion formation after damage to the endometrium, and it can lead to menstrual disturbance (including hypomenorrhea and secondary amenorrhean, et al), cyclical pelvic pain, secondary infertility and other pregnancy complications (recurrent abortion, utero fetal death and abnormal placenta, et al). The intrauterine adhesions can be classified into three types adhesions based on the degree of uterine cavity involvement as visualized via the hysteroscopy:mid, moderate and severe intrauterine adhesions. Patients with mild intrauterine adhesions have the best prognosis, and the severe have the worst. Transcervical resection of adhesions is very popular recently, and it is the standard treatment for intrauterine adhesions. However, the high recurrent rate and low pregnancy rate after surgery always disturb the patients and the doctors, and how to prevent recurrence of the intrauterine adhesion and improve pregnancy rate become the hot and difficult topic. In this study, patients with severe IUA were divided into two groups:the IUD group:an intrauterine contraceptive device (IUD) was inserted into the uterine cavity after TCRA; the Foley catheter+IUD group:a Foley catheter inflated with saline(about3-5ml) were left intrauterine after TCRA then after three days the Foley catheter was removed and an IUD was inserted into the uterine cavity instead. The recurrent rate and pregnancy rate of the two groups were compared to search an efficient method to prevent recurrent of the intrauterine adhesions.Materials and Methods1ObjectsThe current study includes120women with severe IUA who underwent hysteroscopic treatment of intrauterine adhesions at the Third Affiliated Hospital of Zhengzhou University from July2009to December2010.The mean age(±SD) was31.4years±4.6(range22-43years), and the duration of the disease ranged from2months to4years.All the patients didn’t have any serious systematic diseases, and the endocrine examination was normal. Women who wanted to be pregnancy also conformed to standards as follows:1)having normal ovulation(through B ultrasonic monitoring).2) Semen analysis of the spouse was normal.3) Didn’t have other diseases that led to Infertility. All the patients were diagnosed according to March classification method: Mild:Less than a fourth of uterine cavity involved; thin or filmy adhesions; ostial areas and upper fundus minimally involved or clear; Moderate:One fourth to three fourths of uterine cavity involved; no agglutination of walls; adhesions only; ostial areas and upper fundus only partially occluded; Severe More than three fourths of uterine cavity involved; agglutination of walls or thick bands; ostial areas and upper cavity occluded.2Surgery method and post-operation treatmentHysteroscopic lysis of adhesions was performed in all the patients, and transabdominal ultrasound was used to help guide the procedure. When the surgery was finished, the patients were treated with the insertion of an intrauterine contraceptive device (IUD) or a Foley catheter. Postoperative estrogen therapy was given to all patients for2months.3Group divided and follow-upThey were divided into two groups:IUD group and Foley catheter+IUD group. The IUD group (61cases) were treated with the insertion of an intrauterine contraceptive device (IUD) after adhesiolysis and in the Foley catheter+IUD group a Foley catheter inflated with saline(about3-5ml) were left intrauterine then after three days the Foley catheter was removed and an IUD was inserted into the uterine cavity instead. After two consecutive withdrawal vaginal bleedings the IUD was removed in both of the groups. The procedure was repeated if the intrauterine adhesion still persisted. The restoration of uterine cavity, improvement of menstruation and pregnancy rate were observed. The patients were followed-up for6to24months, and the median follow-up time was16months.4Statistical analysisStatistical analyses were performed by using SPSS18.0software package, and we used independent-sample t tests to compare continuous variables and chi-square tests for proportions. The inspection standard is a=0.05.ResultThe recurrent rate of Foley catheter+IUD group was16.9%, lower than the IUD group32.8%(P<0.05).In the Foley catheter+IUD group,96.6%of the patients’ menstruation condition were improved compared with85.2%in the IUD group (P<0.05). The conception rate in the catheter+IUD group was38.5%, compared with33.9%in the IUD group, there was no statistically significant difference between the two groups(P>0.05). ConclusionIntrauterine balloon application combined IUD after transcervical resection of adhesions is of great value in preventing recurrence of intrauterine adhesions and improving menstruation pattern. |
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