The Prevention Of Intrauterine Adhesions Formation By Sodium Hyaluronate Film After Hysteroscopic Electrosurgery

Background: With application of universal hysteroscopy, Asherman as one of postoperative complications has drawn increasing attention, especially after the surgery of transcervix resection of endometrium the incidence of intrauterine adhesions is higher. Domestic and foreign researchs have been trying to find a safe and effective method to prevent Asherman, the 1960s has been trying to human endometrium, or tubal endometrial implantation of intrauterine fetal membranes to stimulate endometrial repair, and some of after surgery placing in the uterine cavity with estrogen and antibiotics, gauze, or cotton Cypriots, but are not sure of. In recent years, Burns, Thornton, Johns proved that sodium hyaluronate gel with disordered network structure can make surgical wound space seperated; inhibit capillary bleeding and reduce blood clots permanent adhesion skeleton number of organizations to avoid contact surface fibrin calmly and have anti-inflammatory properties ,the effectness to prevent the formation of basins and abdominal adhesions is notable.Tsapanos.ect make self-crosslinking sodium hyaluronate gel applied to prevent the Asherman, s formation after hysterospic resection and proved its effectiveness. Chemically synthesized by hyaluronic acid and hydroxymethyl cellulose bioabsorbable membrane-Seprafilm stored in the uterine cavity within two hours can be completely absorbed so that it can prevent the formation of Asherman.The study abroad showed the results that intrauterine placed this film dengan three months can significantly reduce Asherman,s incidence and the severity , its long-term effectness remains to be further follow-up observation.The domestic aobservations for it are few.Objective: This study was prospective, randomized, controlled study, applying hysteroscopic review to evaluate the effectness and the security of sodium hyaluronate membrane sticker (Nien-stop, basically the same composition with Seprafilm)preventingthe formation of Asherman after hysteroscopic resection Methods: Collecting the women who in the second clinical hospital of Jilin University from March 2006 to January 2008 receiving Hysteroscopic surgery 76 cases.They Were randomly divided into two groups: 38 patients observed, after Hysteroscopic resection sodium hyaluronate film placed into the uterine;control group of 38 cases, after Hysteroscopic resection making any disposal. Respectively after a month, three months to out-patient hysteroscopy review, the evaluation of the incidence of intrauterine adhesions, and the types of adhesion, and the degree of adhesion intrauterine wound healing.Results: 1,A month later the observed group and the controled group Asherman incidence is respectively 10.5% (4 / 38) and 65.8% (25/38), the rate of Asherman in sodium hyaluronate group is significantly reduced (P <0.05), three months later the incidence of Asherman in observed group and the controled group respectively is 5.26% (2 / 38) and 23.68% (9 / 38), two groups there were no significant difference (P> 0.05). 2, After a comparison on the types and severity of adhesion in two groups,one month later in the observed group occurred four adhesion cases of which three cases were peripheral membrane adhesion, one case is the central membranous adhesion merger mild cervical adhesions, three month later occurred two adhesion cases which were all adhesions of membrane wall, the severity isâ… degree ; in controled group occurred 25 adhesion cases of which three cases were the membrane adhesion, 22 cases were the muscle fibers adhesion, three cases wereâ… degree, 13 cases wereâ…¡degree , six cases wereâ…¢degree, three cases wereâ…£degree, of which two cases wereâ…¤a degree , one case wasâ…¤b; after three months occurred 9 adhesion cases of which six cases wereâ… degree, two cases of adhesion wereâ…¡degree, one case was severe cervix adhesion merger intrauterine blood. 3, after a horizontal comparison, the occurrence of Asherman in patients with various ages after transvercix resection of endometrium showed that P <0.05, the occurrence of Asherman was significantly different in ages, the smaller the risk of postoperative adhesions higher. 4,Wound <1 / 2 intrauterine area the adhesion rate was 12% (3 / 25), wound> 1 / 2 intrauterine area the adhesion rate was 47% (24/51), compared two grpups the result is x2 = 11,856 , P <0,01, the difference was significant. 5.The speed of wound healing in two groups has no sifigant difference.6.The patients of two groups after surgery were all with vaginal fluid from 3 to 10 days, the observed group has no discomfort.Conclusions: 1. Any making endometrium injured factors may also lead to intrauterine adhesions, intrauterine operation is the main reason. 2, Age is one of the factors which effect the rate of adhesion formation after hysterospic resection, the younger the easier to formate intrauterine adhesion. 3, The occurrence of intrauterine adhesions is related to the area of surgical trauma. 4, Hyaluronic acid film can effecttivlly reduce postoperative adhesions and fibrosis and not affect the speed of wound healing, but the short-term preventive roll is notable, long-term effect is poor. 5,The application of sodium hyaluronate is safe, and which has less side effects.