Evaluation Of The Efficacy Of COOK Intrauterine Balloon Combined With Estrogen And Progesterone In The Treatment Of Intrauterine Adhesion

Objective:To assess the efficacy of different estrogen and progesterone use methods and the different placement time of COOK intrauterine balloon in preventing postoperative recurrence of intrauterine adhesionsMethods:Retrospective analysis of 141 patients with moderate-to-severe intrauterine adhesions from January 2015 to June 2018 at the Zhongda Hospital affiliated to Southeast University,divided into four groups according to their different treatments.A group(30 cases): a heart-shaped intrauterine balloon was placed inflated in the uterus after HEOS cold knife surgery for 7 days,combined with Progynova ?Fenton and Aspirin.B group(45 cases): a heart-shaped intrauterine balloon was placed inflated in the uterus after HEOS cold knife surgery for 30 days,combined with Progynova ?Fenton and Aspirin.C group(33 cases): a round IUD was placed inflated in the uterus after HEOS cold knife surgery,combined with Progynova ?Fenton and Aspirin.D group(33 cases): a round IUD was placed inflated in the uterus after HEOS cold knife surgery,combined with Progynova and Dydrogesterone.The age of each group,the number of preoperative intrauterine operations(including induced abortion,hysteroscopy and other intrauterine operations),preoperative AFS score,preoperative menstrual status,postoperative menstrual improvement,and postoperative AFS were counted.Indicators and total number of reviews,telephone follow-up for each group's birth status.The data obtained were statistically analyzed using SPSS 22.0.Results:1.General situation: A total of 141 patients were included in the four groups.The average age of group A was(33.10±5.43)years old,the average age of group B was(32.42±5.72)years old,the average age of group C was(31.79±4.94)years old,and the average age of group D was(32.30±4.19)years old.The average number of intrauterineoperations in group A was(2.80±1.15)times,the average number of uterine operations in group B was(2.69±1.56)times,and the number of preoperative average uterine operations in group C was(2.21±1.14)times.The number of intrauterine operations in group D was(2.42±1.06)times.The preoperative average AFS score in group A was(7.87±1.38),of which 24 were moderate(AFS score 5-8)and 6 were severe(AFS score 9-12).Group B preoperative the average AFS score was(7.82±1.61)points,of which 36 cases were moderate and 9 cases were severe.The preoperative AFS score of group C was(7.97±1.46)points,of which 24 cases were moderate and 9 cases were severe.The preoperative AFS score of group D was(7.39±1.80)points,of which there were 26 cases with moderate and 7cases with severe.There were no significant differences in age,preoperative uterine operation,preoperative AFS score,and preoperative menstrual status in the four groups(P>0.05).2.Treatment results: Compared with group D,different treatments in group A,group B and group C can reduce the postoperative AFS score and reduce the number of postoperative reexamination.The difference is statistically significant.Compared with group A,the reduction of AFS score and the reduction of the average number of review were more significant in group B,(Z<0.05;P<0.05).The amount of menstruation in group A and group B was significantly higher than that in group C.The difference was statistically significant(P<0.05).There was no significant difference in postoperative menstrual improvement between group A and group B?group C and group D(P>0.05).There was no significant difference in postoperative infection between group A and group B(P>0.05).Group A,group B,and group C improved postoperative fertility compared with group D.Group B had the highest fertility rate,but the difference was not statistically significant,may be limited by sample size and follow-up time(P>0.05).Conclusions:1?Placement of COOK intrauterine balloon in the uterine cavity after the HEOS cold knife surgery compared with the placement of IUD,can improve menstrual flow,reduce postoperative AFS score,reduce the average number of review.2?The postoperative hormone supplement regimen of Progynova combined with Fenton and Aspirin can improve menstrual flow,reduce postoperative AFS score,reduce the average number of review than the single estrogen and progesterone supplement.3?COOK intrauterine balloon placement for one month compared with 7 days,the postoperative AFS evaluation and the average number of review times decreased more significantly.4?COOK intrauterine balloon extended placement does not increase the risk of infection.5?COOK intrauterine balloon combined with Progynova?Fenton and Aspirin treatment may achieve higher fertility.