Clinical Study On Two Methods Of Preventing Adhesion After Intrauterine Adhesion Dissection

Objective:transcervical resection of adhesions（TCRA）is the preferred method for treatment of intrauterine adhesions（IUA）.With the recurrence rate of postoperative intrauterine adhesion relatively high,the prevention and treatment of postoperative adhesion is still the key.There are no standard methods to prevent re adhesion after operation,placing IUD,placement of Foley catheter balloon,artificial cycle,application of anti adhesion agent.This paper will compare two methods,IUD placement combined with taking E₂V and balloon placement combined with taking E₂V,and then find out the better treatment to prevent re adhesion.Methods:1.42 cases from March 2013 to February 2015 in the People’s Hospital of Xishan,diagnosed as moderate and severe intrauterine adhesion,were collected and randomly devide into two groups.Both group have 21 cases.Group A were chosen different types of metal rings according to the uterine size after TCRA,given postoperative antibiotic to prevent infection.Everyone began to take E₂V from the second day of surgery.From the second week of medication,do a weekly review of a transvaginal ultrasound and monitor the endometrial thickness.When it’s reached about 7 mm or more,add medroxyprogesterone acetate tablets 10mg/d,a total of 10 days,withdrawal bleeding,for a week treatment period.On the first 5 days of menstruation（ie,withdrawal bleeding on day 5）,start the second treatment cycle,taking estradiolvalerate again.Group B were placed Foley balloon catheter after TCRA.According to the size of the uterine cavity,inject 3ml to 5ml of physiological saline into the balloon,taking the situation of not sliding out of the uterine cavity as the standard.Give antibiotics to prevent infection,draw off saline from the balloon after 72 hours,then,pull out the balloon.Also Take estradiol valerate tablets from the second day of operation.Taking methods,measurement,time,and adding medroxyprogesterone time can be referred to Group A.Withdrawal bleeding is a treatment cycle.On the first 5 days of menstruation（ie,withdrawal bleeding on day 5）,start the second treatment cycle.2.Observational index Review hysteroscopy after 3 treatment cycles to understand uterine shape,and follow up the recovery period.Transforming growth factor beta 1（TGF-β1）and tumor necrosis factor alpha（TNF-a）were observed in the two groups.TGF-β1 and TNF-a were detected by immunohistochemical SP method in the two groups.3.Statistical methods:All the data were processed by SPSS19.0,the measurement data using the mean and standard deviation,were compared by t test in the two groups.Counting data were used by chi square test in the two groups.P<0.05 was statistically significant difference.Results:1.The average amount of pre-menstruation in Group A patients was 12.67±4.82ml,after the third postoperative menstrual cycle（withdrawal bleed）an amount of32.33±10.66ml.The menstrual flow difference of Group A between before and after surgery was statistically significant（P<0.05）.The average amount of pre-menstrual in Group B patients was 13.05±5.32ml,after the third postoperative menstrual cycle（withdrawal bleed）an amount of 39.38±10.86ml.The menstrual flow difference of Group A between pretherapy and after three cycles of treatment wasn’t statistically significant（P<0.05）.The menstrual flow difference of each group after treatment was statistically significant（P<0.05）.2.In the first circle,the average period of taking E₂V,Group A,46.67±19.72 days,and Group B,40.33±11.90 days.The difference was statistically significant（P<0.05）.3.Review hysteroscopic after 3 treatment cycles to evaluate efficacy,Group A one case completely cured,17 cases improved,3 cases ineffective,the cure rate was 4.76%,14.29%inefficiency,Group B 5 cases completely cured,15 cases improved,1 patient ineffective,the cure rate 23.81%,4.76%inefficiency.With comparison of the two groups,the difference was statistically significant（P<0.05）.4.The number of TCRA again after TCRA,Group A 2.14±0.73times,Group B1.38±0.59 times,the difference was statistically significant（P<0.05）.5.Before and after taking a lot of estrogen,compare the clotting function,liver function,blood lipids and breast ultrasound of every patient,the difference was not statistically significant（P>0.05）.6.Before treatment,there were no statistically significant in TGF-β1and TNF-αin thetwo groups（P>0.05）;after treatment,TGF-β1and TNF-αwere significantly decreased in the two groups（P<0.05）,but TGF-β1and TNF-αin the group B were significantly lower than those in the group A（P<0.05）.Conclusion:1.Do TCRA for moderate and severe intrauterine adhesion patients.Place postoperative IUD or Foley catheter balloon joint oral estrogen and progesterone artificial cycle therapy.It has some effect to improve the menstrual flow and prevent postoperative adhesions.2.Place Foley catheter balloon after TCRA combined with high dose of estrogen is obviously better than placing IUD after TCRA combined with high dose of estrogen.3.Take large doses of estradiol valerate in 3 to 9 months,no childbearing age woman has been obviously affected in terms of clotting function,liver function,blood lipids and breast.