| OBJECTIVE:TO observe the therapeutic effect of amniotic membrane transplantation on the prevention of intrauterine adhesions after transcervical resection of adhesions.To retrospectively analyze 96 patients with intrauterine adhesion who were treated with three different methods to prevent intrauterine adhesion after transcervical resection of adhesions(TCRA),to compare the advantages and disadvantages of each treatment,and the effects of each treatment on the prevention of intrauterine adhesion,as well as the effects on postoperative menstruation,abdominal pain and pregnancy,so as to evaluate the therapeutic value of amnion on intrauterine adhesion(IUA),in order to assess the value of amniotic membrane transplantation for intrauterine adhesions.MATERIALS AND METHODS:In accordance with the strict inclusion and exclusion criteria,96 patients admitted and treated in our hospital from January 2015 to March 2018 who were diagnosed with intrauterine adhesion by hysteroscopy were selected as the research objects.After the TCRA,different methods were adopted to prevent the recurrence of intrauterine adhesion,which were divided into three groups according to different treatment methods:Balloon group:intrauterine indwelling Foley balloon was placed after TCRA surgery,3-5ml normal saline was injected into the balloon,and the balloon was removed after 7 days.IUD group:intrauterine placement of "T" type IUD after TCRA was performed,and the IUD was returned to the hospital for removal 2 months after the operation.Amniotic membrane group:appropriate size of amniotic membrane package together into uterine cavity on the Foley balloon,a balloon for 3 to 5 ml normal saline,and with catheter drainage bag.Pull Foley balloon after 7 days,trying not to be brought out the membrane.After 2 months back to the hospital for hysteroscopy examination,take out intrauterine residual amniotic membrane.Amniotic membrane from the day of cesarean section patients,no infectious diseases,and pregnant women agreed to discard the placenta or for other medical purposes.Will appropriate amniotic membrane to remove from the placenta,rinse with physiological saline,save in the metronidazole solution for use,all operations are conducted in a sterile environment.All patients in the three groups were given oral antibiotics for three days to prevent infection,and oral drugs were given for artificial cycle treatment to repair the intima on the first day after surgery:estradiol valerate was given 3mg once a day for 21 consecutive days,and dydrogesterone was added 10 days later for 10mg once a day to form retreating bleeding.The following menstrual cycle began to repeat the above medication on the 5th day of menstruation for 2 consecutive menstrual cycles.All the patients in the three groups were returned to the hospital for the second hysteroscopic examination after 2 months treatment,and the condition of intrauterine adhesion was re-evaluated.The IUD group was removed from the intrauterine contraceptive device,and the amniotic membrane group was removed from the intrauterine residual amniotic membrane.If adhesion was formed and separated again,the same method was used to prevent intrauterine adhesion again if necessary.The three methods were analyzed and compared using statistical methods.SPSS22.0 statistical software was used to analyze the data.P<0.05 was considered statistically significant,while P<0.01 was considered statistically significant.RESULTS:1.From the perspective of the included cases,the incidence of intrauterine adhesion showed an increasing trend year by year,which was consistent with the incidence trend of intrauterine adhesion in China in recent years.2.Age analysis of intrauterine adhesion:among the 96 patients in this study,the minimum age was 22,the maximum age was 45,and the average age was(32.26±4.78).23 patients in the balloon group were between 22 and 43 years old,with an average age of(31.41±5.35)years.29 patients in the IUD group were 27 to 45 years old,with an average age of(33.14±4.84)years.The age of 44 patients in the amniotic membrane group ranged from 24 to 43 years old,with an average age of(32.39±5.25)years.There was no significant difference in age among the three groups(P=0.488).3.Clinical manifestations of intrauterine adhesion:from January 2015 to March 2018,47 of the 96 intrauterine adhesion patients admitted to our hospital with the chief complaint of "decreased menstruation",accounting for 49%of the total number 24 patients were admitted to the hospital with "secondary amenorrhea" as the chief complaint,accounting for 25%of the total number.10 patients were admitted to hospital with the chief complaint of "infertility"(excluding other infertility factors),accounting for 16%of the total number.The chief complaint of "uterine adhesion found by b-mode ultrasonography" was 15 cases,accounting for 10%of the total number.Therefore,the main clinical manifestation of intrauterine adhesion patients is menstrual changes.4.Through comparative analysis,there were statistically significant differences in the clinical efficacy of different methods to prevent the recurrence of intrauterine adhesion after TCRA among the three groups(P=0.026).Further analysis showed that the amniotic membrane group had the highest total efficiency,the balloon group had the higher total efficiency,the iud group had the worst total efficiency,and the amniotic membrane group had the highest significant efficiency,the balloon group had the higher significant efficiency,and the iud group had the worst significant efficiency.5.The recovery of intrauterine adhesion in the three groups was statistically significant(P=0.024).The amniotic membrane group had the highest improvement rate of uterine cavity morphology.After further comparison between the two groups,the difference in the recovery of intrauterine adhesion mainly existed in the IUD group and the amnion group(P=0.018),while the difference between the balloon group and the IUD group(P=0.143)and between the balloon group and the amnion group(P=0.570)was not statistically significant.6.In terms of menstrual recovery,the recovery rate of the amniotic membrane group was 78.79%,that of the balloon group was 60.00%,and that of the IUD group was 47.83%.After statistical analysis,the recovery of menstrual volume in the three groups was statistically significant(P=0.040).This differencewas reflected in the IUD group and the amnion group(P=0.041),while there was no significant difference between the balloon group and the IUD group(P=0.730)and between the balloon group and the amnion group(P=0.360).7.The number of cases of intrauterine adhesion in the balloon group was 19,with an improvement rate of 82.61%,while the number of cases of menstrual improvement was 9,with an improvement rate of 60.00%.In the IUD group,the improvement rate of intrauterine adhesion was 68.97%in 20 cases,and the improvement rate of menstruation was 47.82%in 11 cases.In the amniotic membrane group,there were 40 cases with improvement of intrauterine adhesion,with an improvement rate of 90.91%,while there were 26 cases with improvement of menstruation,with an improvement rate of 78.79%.8.One year after the operation,the number of pregnancy cases in the amniotic membrane group was 20,and the pregnancy rate was 20.83%;the number of pregnancy cases in the balloon group was 8,and the pregnancy rate was 8.33%;the number of pregnancy cases in the IUD group was 6,and the pregnancy rate was 6.25%CONCLUSION:After TCRA,all of three different methods had clinical efficacy.However,the most significant clinical effect was amniotic membrane group.The amniotic membrane group had the highest improvement of intrauterine adhesion,menstrual recovery and postoperative pregnancy rate. |
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