| Background and ObjectiveIntrauterine adhesions(IUAs)are multiple factors that cause endometrial basal layer injury and endometrial fibrosis,causing part or all of the intrauterine adhesions,which are manifested as decreased menstrual volume,amenorrhea,recurrent abdominal pain,infertility and recurrent abortion,and seriously endanger the reproductive health of women of childbearing age.With the change of people's sexual consciousness,the lack of sex education and the increase of accidental pregnancy rate,induced abortion as a major remedy for contraceptive failure,among which surgical abortion accounts for the majority.In recent years,with the promotion and application of painless abortion technology,the incidence of intrauterine adhesions after painless abortion has increased year by year.Multiple uterine adhesions caused by uterine curettage and induced abortion during pregnancy can be up to 25-30%,the literature reported.With the development of hysteroscopy technology,the diagnosis rate of intrauterine adhesion is obviously improved,and hysteroscopy is the gold standard for the diagnosis of intrauterine diseases.At the same time,transcervical resection of adhesions(TCRA)is an effective and minimally invasive method to restore the intrauterine anatomy.Some scholars pointed out that the incidence of postoperative re-adhesion in patients with moderate intrauterine adhesions was 16%,and the incidence of postoperative re-adhesion in patients with severe intrauterine adhesions was 62.5%.Even if the normal anatomical morphology of uterine cavity is restored,the repair of endometrial wound after surgery is still a thorny problem.Estrogen therapy after intrauterine adhesion separation is currently the treatment method generally accepted by domestic and foreign scholars,but the effect of estrogen therapy alone is still not good,the reason is that the damaged endometrial estrogen receptor and the remaining endometrial content are reduced.Currently,caused by intrauterine adhesions comprehensive treatment method,which is given priority to with estrogen therapy combined adjuvant treatment methods,such as: intrauterine placed synthetic,placed Foley balloon,hyaluronic acid gel or amniotic membrane,etc.,using the physical barrier,support the uterus,in order to reach the effect of postoperative uterine cavity adhesion separation,decrease the rate of complex adhesive,so as to improve birth outcomes.Endometrial repair mainly relies on endometrial blood flow to provide nutrients.Currently,scholars have applied multiple drugs to improve endometrial blood supply,and used clinical ultrasound technology to predict the effectiveness of treating endometrial blood flow.Therefore,according to the theory that the heart "pumps" blood,whether the uterine cavity can improve the distribution of endometrial blood flow through the change of pressure is put forward.This study focused on the use of physical methods other than drugs to improve endometrial blood flow.That is to say,patients with IUA received Foley balloon massage therapy 3-4 times a month after surgery.The operation method of massage therapy was to inject 3-5ml normal saline with 16fr-10 ml double-chamber balloon catheter,and the contraction and expansion were repeated for 15-20 times.By changing the pressure difference in the uterine cavity,the blood flow distribution in the endometrium is changed,and the abundant blood around the uterus is introduced into the endometrium and the area with sparse blood vessels under the endometrium,so as to deliver more nutrients,establish new collateral circulation and promote the repair of the endometrium.In this paper,the efficacy of Foley balloon massage was evaluated by analyzing the endometrial blood flow signals,menstrual patterns and uterine cavity morphology of the control group and the balloon massage group for three months,so as to provide a new therapeutic measure for clinical workers.Materials and Methods1.MaterialsProspective study of clinical data of 89 patients with intrauterine adhesions in our hospital from December 2017 to June 2018 in the Second Affiliated Hospital of Zhengzhou University.The age ranged from 24-47 years old,with an average age of 32.08±0.48 years,and the course of disease ranged from 3 months to 3 years.Among them,there were 61 cases of induced abortion,21 cases of missed abortion,4 cases of mid-pregnancy induced abortion,and 1 case of tuberculosis history.1 case of tuberculosis history,1 case of unknown cause.According to the time of reviewing hysteroscopy,the patients were divided into balloon massage group(45 cases)and control group(44 cases)according to random number method.2.Methods2.1 Medication methods1 to 3 months after the operation,and 3-7 days after the menstruation was clean,the outpatient department of our hospital conducted re-examination.Before the re-examination of hysteroscopy,three-dimensional vaginal ultrasonography was performed before the color doppler ultrasound room of our hospital,and the blood flow of the endometrium VI,FI and VFI,and the blood flow PI and RI under the endometrium were measured.During the 3-month follow-up,the measured values were recorded each time.All the image collection and data processing were completed by the same experienced ultrasound physician.Balloon massage group: When the hysteroscopy is performed,the morphology of the patient's uterine cavity,uterine fundus,uterine horn,oviduct,endometrium,and cervix is recorded.If there is adhesion in the treatment,the scissors are used directly.After surgery,use 16Fr-10 mL.The double-chamber balloon catheter was injected with 3-5 ml of normal saline,and the contraction-expansion was repeated for 15-20 times.The lens was again placed to observe the morphology and color of the uterus,and the depth of the uterus after the expansion was measured.The surgeon according to the hysteroscopy of the patient,The patient is dilated once every 7 days until one week before menstruation.Observation group: When the hysteroscopy was performed,the patient took the lithotomy position,routinely disinfected the towel,and placed the examination mirror No.4.5 to record the morphology of the patient's uterine cavity,uterine fundus,uterine horn,oviduct,endometrium,and cervix.In the case of adhesion,the scissors are directly treated,and the surgery is completed.2.2 Statistical methodsData analysis was performed using statistical software SPSS22.0.The measurement data is expressed by(sx ±),and the t test is applied;the count data is expressed as a percentage,and the test is applied.P<0.05 indicates that the difference is statistically significant.Results1.Analysis of endometrial blood flow after Foley balloon massage for 3 monthsAfter Foley balloon massage treatment for 3 months,the endometrial blood flow VI of the control group and the balloon massage group were(2.60±0.43),(3.97±0.35),FI(20.16±0.74),(26.49±0.59),VFI(1.61±0.28),(2.84±0.33),and subendometrial blood flow PI(0.79±0.03),(0.70±0.02),RI(0.68±0.01),and(0.53±0.01),respectively.After Foley balloon treatment,endometrial blood flow and subendometrial blood flow were significantly improved compared with the control group(P<0.05).2.Analysis of menstrual patterns after Foley balloon massage therapy for 3 monthsThree months after Foley balloon therapy,the menstrual improvement in the control group and the balloon massage group was 79.5% and 75.6%,respectively,with no significant difference between the two groups(P>0.05).3.Analysis of uterine cavity morphology after Foley balloon massage therapy for 3 monthsThree months after Foley balloon therapy,the intrauterine readhesion rates of the control group and the balloon massage group were 34.1% and 13.3%,respectively,with statistically significant differences(P<0.05).Conclusion1.Foley balloon massage therapy can improve endometrial blood flow and is a contributing factor to endometrial repair.2.Foley balloon massage therapy can improve uterine cavity morphology and reduce the recurrence rate of uterine cavity adhesion.3.Foley balloon massage is a simple and effective new method to prevent postoperative adhesion,which is worthy of further study. |
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