Analysis Of Prognostic Factors After Transcervical Resection Of Adhesions On Severe Intrauterine Adhesion Patients And Application Of Uterine Shape Adhesion Separation Shovel In Severe Intrauterine Adhesion Disease

Objective:1.To discuss the clinical effect and prognostic factors of severe IUA by analyzing retrospectively the clinical datas of the 78 patients.2.To evaluate the feasibility and efficacy of application of uterine shape adhesion shovel in hysteroscopic adhesiolysis.Methods:Part one: A retrospective analysis was carried out to explore the clinical datas of 78 cases of severe intrauterine adhesion patients who were treated in the Gynecology of the second affiliated hospital of Soochow university from February 2010 to December 2016.In order to explore the severe prognostic factors of sever intrauterine adhesions,and evaluate different treatment's effect and its influencing factors.All datas were analysed by statistical software.Part two: 13 patients desired pregnancy and tentatively diagnosed with severe intrauterine adhesions were recruited from February 2016 to February 2017 in the Gynecology of the second affiliated hospital of Soochow university and prepared to be treated by TCRA.All of the 13 patients were in the group according to the inclusion criteria and exclusion criteria.Their therapy plan included TCRA with uterine shape adhesion shovel and postoperative adjuvant treatments.The preoperative mense preoperative adhesion level,postoperative mense,postoperative adhesion level in third month and postoperative fecundity with three years were gathered from them.The effective rate of TCRA with uterine shape adhesion shovel were calculated by the changes of mense and adhesion level.Compared the effective rate of TCRA with uterine shape adhesion shovel with the rate in literature and then evaluate the feasibility and efficacy of application of uterine shape adhesion shovel in TCRA.Results:Part one: A retrospective analysis of 78 cases of severe IUA patient,the age was(30.9±4.8)years,the disease course was(10.2±2.1)months and had a history of(2.3±1.2)times induced abortion.Their main complain was hypomenorrhea,amenorrhea,recurrent pregnancy loss or infertility.According to the classification,the severity of IUA is scaled from mild(41 cases)to severe(37 cases).The success rate of once attempt was 80.8%(63/78)and twice attempts 93.6%(73/78).The effective rate of once attempt was 76.9%(60/78)and twice attempts 91.0%(71/78).The rate of perforation of the uterus was 1 of 99(1.0%).TCRA was effective treatment for IUA and the rate of poor prognosis was 23.1%.Several factors were positively correlated with patient prognosis(including the level of adhesion and the method of surgery).Part two: A retrospective analysis of 13 cases of severe IUA patient,the age was(30.9±4.8)years,the disease course was(7.5±4.3)months and had a history of(2.4±1.2)times induced abortion.Their main complain was hypomenorrhea,amenorrhea,recurrent pregnancy loss or infertility.According to the classification,the severity of IUA is scaled from mild(6 cases)to severe(7 cases).The success rate of once attempt was 92.3%(12/13)and twice attempts 100%(13/13).The effective rate of once attempt was 90%(9/10)and twice attempts 100%(10/10).The rate of spontaneous adhesion reformation was 20%(2/10)and the rate of perforation of the uterus was 0 of 17.There have been two patients pregnancy so far and one of them have been parturition.Conclusions:1.Several factors were positively correlated with patient prognosis(includingthe level of adhesion and the method of surgery).2.As a new surgical instrument,uterine shape adhesion shovel could be used safely in TCRA and resulted significant curative effects of the severe intrauterine adhesions.