Clinical Study On The Prevention Of Recurrence Of Moderate And Severe Intrauterine Adhesions By Three Kinds Of Adjuvant Therapy

Objective:To explore the clinical effect of three auxiliary treatment methods after the separation of moderate and severe intrauterine adhesions,and to provide reference for the prevention of re-adhesion by comparing the curative effects of the three methods.Methods:A total of 90 patients with moderate and severe uterine adhesions diagnosed by hysteroscopy in the gynecology clinic of the Fifth affiliated Hospital of Guangxi Medical University from January 2018 to January 2019 were randomly divided into three groups with 30 cases in each group.They all have fertility requirements.after admission,uterine adhesion separation was performed.Group A: sodium hyaluronate gel + artificial cycle after operation.Group B: Foley balloon catheter + sodium hyaluronate gel + artificial cycle after operation.Group C: Cook balloon + sodium hyaluronate gel +artificial cycle after operation.All the three groups returned to hospital for hysteroscopy to evaluate the menstrual flow,endometrial thickness and adhesiolysis in third months after operation,and then to guide the conception or accept assisted reproductive technology,and follow up the pregnancy rate in sixth months.Results: 1.General factors: including age,menarche,pregnancy,uterine cavity operation times,course of disease,endometrial thickness before operation,degree of uterine cavity adhesion,there was no significant difference(P>0.05).2.Hysteroscopy was reexamined to evaluate the intrauterine adhesions after the operation three months later: The rates of intrauterine adhesion were66.67% in group A,40.00% in group B and 36.67% in group C.There was significant difference between group A and group B,between group A and group C(P<0.05).There was no significant difference between group B and group C(P>0.05).3.The improvement of menstruation after operationin in fourth months : The effective rate of menstruation improvement in group A,group B and group C was 56.67%,73.33% and 63.33% respectively,there was no significant difference between the three groups(P>0.05).4.Endometrial thickness: the endometrial thickness of the three groups after operation increased significantly compared with that before operation,and there was no significant difference between the three groups(P>0.05).5.The pregnancy rate of group A was 16.67%,group B was 23.33%,and group C was 26.67%.There was no significant difference between the three groups(P>0.05).6.Comparison of therapeutic effects between moderate and severe IUA patients: there were significant differences in uterine re-adhesion rate,menstruation improvement rate,endometrial thickness and pregnancy rate between moderate and severe uterine adhesions(P<0.05).Conclusion:The effect of Foley balloon or Cook balloon + sodium hyaluronate gel + artificial cycle adjuvant therapy on prevention of intrauterine adhesions after moderate and severe intrauterine adhesion separation is significantly better than that of postoperative sodium hyaluronate gel + artificial cycle adjuvant therapy,but there is no significant difference in the improvement of menstrual volume and pregnancy rate.The efficacy of three adjuvant treatments for moderate uterine adhesion is better than that of severe uterine adhesion.