| Objective:To compare the clinical efficacy of COOK uterine balloon stent combined with intrauterine device,COOK uterine balloon stent and intrauterine device(IUD)in preventing recurrence of adhesion in moderate and severe intrauterine adhesion(IUA)patients after transcervical resection of adhesion(TCRA),and to analyse the clinical efficacy of COOK uterine balloon stent combined with intrauterine device in preventing adhesion recurrence after TCRA.The purpose of this study is to guide the clinic to find the best method to prevent the recurrence of intrauterine adhesion after TCRA.Methods:From January 1,2017 to December 31,2019,324 patients with moderate and severe IUA in Northwest Women’s and Children’s Hospital were selected to undergo TCRA,and met the inclusion and exclusion criteria.According to the wishes of the patients,the measures to prevent the recurrence of intrauterine adhesion were selected and divided into three groups: group A(n=135),COOK uterine balloon was placed in uterine cavity after operation.Five days later,uterine balloon was removed and IUD was placed for 1 month.In group B,98 patients were treated with uterine balloon after 5 days,and 90 patients in group C were treated with intrauterine device for 1month.After TCRA,all the three groups were given intravenous antibiotics for 24 hours to prevent infection,and artificial cycles were given for 3 courses of treatment.At the first month after operation,all the patients in the group returned to the hospital for hysteroscopic examination.at the same time,the IUD was removed in group A and group C,and the intrauterine morphology and menstrual recovery were recorded.The pregnancy of the patients was followed up one year after operation.By analyzing the clinical data of three groups of patients(general condition: age,menstrual cycle,days of menstruation,menstrual quantity,times of pregnancy,times of delivery,total times of TCRA,history of cesarean section,history of uterine clearance,type of intrauterine adhesion,AFS score before treatment.Intraoperative conditions: the whole operation time,intraoperative blood loss)comparison of the three groups of patients with Efficacy of preventing recurrence of adhesion,postoperative menstruation improvement rate,postoperative AFS score,postoperative complications and postoperative pregnancy.Based on the above indexes,the clinical efficacy of COOK uterine balloon combined with intrauterine device in preventing recurrence of intrauterine adhesion after TCRA was analyzed.Binary Logistic regression analysis was used to analyze the factors that may affect the success of pregnancy after intrauterine adhesion,and to explore the main factors affecting the success of pregnancy after TCRA.Results:1.There was no significant difference in general conditions(age,menstrual cycle,days of menstruation,menstrual quantity,times of pregnancy,parturition,total times of uterine cavity operation,history of cesarean section,history of uterine clearance,type of uterine adhesion,AFS score before treatment)and intraoperative conditions(whole operation time and intraoperative blood loss)among three groups(P>0.05).2.Efficacy of preventing recurrence of adhesion and menstruation improvement in patients with moderate uterine adhesion: in group A,the total effective rate of preventing recurrence of adhesion was 100%(90/90),menstruation improvement rate was 94.4%(85/90);in group B: the total effective rate of preventing recurrence of adhesion was 98.6%(70/71),menstruation improvement rate was 88.7%(63/71);C group,total effective rate of preventing recurrence of adhesion was 90.5%(57/63),menstruation improvement rate was 79.4%(50/63).The total effective rate of preventing recurrence of adhesion(χ2=6.573,P=0.010)and menstruation improvement rate(χ2=8.118,P=0.004)in group A were significantly higher than those in group C(P<0.017).3.Efficacy of preventing recurrence of adhesion and menstruation improvement in patients with severe uterine adhesion: total effective rate of preventing recurrence of adhesion in group A was 97.7%(44/45),the rate of menstruation improvement was84.4%(38/45);The total effective rate of preventing recurrence of adhesion in group B was 77.8%(21/27),and the menstruation improvement rate was 55.6%(15/27);C group,total effective rate of preventing recurrence of adhesion was 75.0%(21/28),and the menstruation improvement rate was 57.1%(16/28).The total effective rate of preventing recurrence of adhesion in group A was significantly higher than that in group B(χ2=7.691,P=0.006)and group C(χ2=6.991,P=0.008)(P<0.017),and the menstrual improvement rate in group A was also higher than that in group B(χ2=7.250,P=0.007)and group C(χ2=6.682,P=0.010)(P<0.017).4.The postoperative AFS scores of patients with moderate and severe intrauterine adhesion were lower than those of preoperative AFS scores,and the difference was statistically significant(P<0.05).The postoperative AFS score of patients with moderate intrauterine adhesion in group A was significantly lower than that in group C(Z=3.531,P<0.001),and the difference was statistically significant(P<0.017).The postoperative AFS of patients with severe intrauterine adhesion in group A was significantly lower than that in group B(Z=3.691,P<0.001)and group C(Z=3.305,P = 0.001),and the difference was statistically significant(P<0.017).5.Comparison of postoperative complications of moderate and severe intrauterine adhesion: there were no uterine infection,uterine perforation and vaginal bleeding in group A(n=135)and group B(n=98).Among the patients with moderate intrauterine adhesion,group C(n=63)had 1 case of uterine infection(1.6%)and 1case of intrauterine device incarceration(1.6%).Group C(n=28)with severe uterine adhesion had 1 case of uterine infection(3.6%)and 2 cases of IUD incarceration(7.1%).6.Comparison of postoperative pregnancy rates among the three groups: there was no significant difference in postoperative pregnancy rate among three groups in patients with moderate and severe intrauterine adhesion(P>0.05).7.Multivariate Logistic regression analysis showed that age(OR=0.906,95%CI(0.850-0.976)),efficacy of preventing recurrence of adhesione(OR=7.679,95%CI(3.503-16.833))were key factors for successful pregnancy after uterine adhesion.Among them,the age was negatively correlated with the success of postoperative pregnancy,that is,the success rate of postoperative pregnancy was higher in young patients with intrauterine adhesion than in older patients;The efficacy of preventing recurrence of uterine adhesions and the improvement of menstruation were positively correlated with the success of postoperative pregnancy,in other words,the postoperative pregnancy rate of patients with effective treatment was higher than that of patients with ineffective treatment.Conclusion:1.In patients with severe uterine adhesion,COOK uterine balloon stent combined with IUD is superior to COOK uterine balloon and IUD alone in the prevention of adhesion recurrence and the improvement of menstruation after uterine adhesion separation.In patients with moderate uterine adhesion,COOK uterine balloon stent combined with intrauterine device can prevent adhesion recurrence and improve menstruation after uterine adhesion.The curative effect of COOK uterine balloon stent alone is not significantly different from that of COOK uterine balloon stent alone.2.Three different methods to prevent adhesion recurrence after TCRA have no difference in improving the success rate of pregnancy.3.The age of the patients,the efficacy of preventing recurrence of adhesion and the improvement of menstruation after operation are the key factors affecting the success of pregnancy after intrauterine adhesion. |
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