Analysis Of The Effect Of Multiple Cervical Pretreatment Methods In Difficult Operation Of Uterine Cavity

Objective: To evaluation the effects of cervical dilatation,dilatation time,bleeding volume,adverse reactions,post artificial abortion syndrome(PAAS),and visual analogue score(VAS)of the patient after pretreatment of the cervix on those who estimated to have difficulty in performing uterine cavity operation and those who failed first time that need to perform it again.A cost-effective and targeted cervical pretreatment method is proposed to effectively reduce the risk and complications of intrauterine operation.Methods:From September 2018 to January 2020,a total of 355 patients who were required diagnosed and treatment need with uterine cavity operation in the Department of Gynecology of Affiliated Hospital of Qinghai University were selected.The patients were divided into hysteroscopic operation group and non-hysteroscopic operation group according to whether under anesthesia or not.The above two groups were given misoprostol,phloroglucinol,and disposable cervical dilator to pretreat the cervix before the operation,and the degree of cervical dilatation,dilatation time,bleeding volume,adverse reactions,post artificial abortion syndrome and visual analogue score of the patient were be obversed in each groups.Results:(1)There was significant difference in the effective rate of cervical dilatation among the three kinds of cervical pretreatments(p < 0.05).There was significant difference between phloroglucinol group and disposable cervical dilator group(p < 0.0166)in the hysteroscopic operation group.There were significant differences between misoprostol group and phloroglucinol group and between phloroglucinol group and disposable cervical dilator group(p < 0.0166)in the non-hysteroscopic operation group.Among the non-hysteroscopic operate group,the phloroglucinol group had the highest rate of dilation cervix of postmenopausal or non-menopausal patients.Among the postmenopausal women,the misoprostol group had the lowest rate of dilatation,and the diaposable cervical dilator group had the lowest rate of dilatation in the non-menopausal(p < 0.05).Who failed the first uterine cavity operation successfully completed the operation,and no one who failed again,The effective rate of cervical dilatation was 57.14%,54.55%,71.43% and 75.00% in postmenopausal women and non-menopausal women treated with misoprostol and phloroglucinol respectively,there was no significant difference between the two groups.(2)The misoprostol group in the hysteroscopic operation group took the longest time and the most bleeding,the misoprostol group in the non-hysteroscopic operation group took the longest time and the most bleeding too in the postmenopausal patients,and the disposable cervical dilator group in the non-menopausal patients took the longest time and the most bleeding,both were the phloroglucinol group have the shortest dilatation time and least bleeding,there was significant difference among the groups(p < 0.05).(3)The incidence of nausea,abdominal pain,vaginal bleeding and shivering in the misoprostol group was 6.06%,9.09%,3.03% and 3.03% respectively,the incidences of nausea,abdominal pain,diarrhea,vaginal bleeding,chills and fever were 7.53%,9.68%,2.15%,5.38% and 3.23% respectively.In the disposable cervical dilator group and phloroglucinol group,the cervix was treated after anesthesia,and no adverse reaction occurred before operation.In the non-hysteroscopic group,2 cases(2.67%)had nausea in the disposable cervical dilator group and 1 case(1.10%)chilled in the phloroglucinol group.There was no postoperative infection in all three groups.(4)The incidence of PAAS was 14.00% in misoprostol group,6.12% in phloroglucinol group,11.63% in cervical dilator group,and 13.95%,4.76%,15.63%respectively in non-menopausal patients,there was no significant difference among the groups(p > 0.05).The pain score of misoprostol group was the highest in menopausal patients,and that of disposable cervical dilator group was the highest in non-menopausal patients,both of which were the lowest in phloroglucinol group.There was a significant difference between the two groups(p < 0.05).Conclusions:(1)Three different methods of cervical pretreatment before difficult uterine cavity operation can get better cervical treatment effect,effectively reduce the rate of dilatation,cervical compliance increased,the need for expansion of the cervix is also relatively easy to dilate,the time of dilating is shortened correspondingly,which can effectively relieve pain,reduce unnecessary injury and bleeding,and reduce the incidence of PAAS during operation.(2)Phloroglucinol has obvious effect of cervical dilatation,low rate of pain stimulation and adverse reaction,and little allergy.It just not suitable for patients with relative contraindications.There was significant difference between misoprostol group and phloroglucinol group in the efficiency of cervical dilatation.It was considering phloroglucinol dilatation effect was better than misoprostol and disposable cervical dilator group.There was no significant difference between misoprostol group and disposable cervical dilator group in the effect of cervical dilatation.It was considered that there was no significant difference between them.Misoprostol was not available in patients with prostaglandin contraindication and patients with cardiovascular and cerebrovascular diseases,and the incidence of adverse reactions was high,considering that the vaginal environment is not the main factor affecting the efficacy of misoprostol,it may be related to the expression of its receptor.The new water-injection disposable cervical dilator has mild,fast,effective effect,high safety and no toxic side effects.It is still available for those with poor liver and kidney function,and its incidence of adverse reactions and infection rate is low.However,some patients feel uncomfortable when using it,it is difficult for some patients to be placed,which may cause pain and stress stimulation.(3)All operations were successfully performed in the patients who failed the first uterine cavity operation,no patients failed again.The efficiency of cervical dilatation after cervical pretreatment with misoprostol and phloroglucinol was significantly increased,it is proved that sufficient pretreatment of cervix can obviously increase the success rate of operation,but there is no obvious difference between the two methods of cervical dilatation,considering due to less sample size,need further explored.In the clinical application,we should take the patients' condition into full consideration,select the appropriate cervical pre-treatment method according to the patients' basic disease and cervical condition,create the best cervical condition as far as possible,and provide help for the diagnosis and treatment of uterine cavity disease.