Clinical Effect Of Hysteroscopic Cold Knife Separation Combined With Cool Balloon In The Treatment Of Moderate And Severe Intrauterine Adhesions

Background and purposeIn this study,IUA patients were treated with hysteroscopic cold knife operation system separation and energy operation system separation respectively.After operation,cook balloon or IUD were placed to prevent the occurrence of re adhesion,and the most appropriate treatment scheme was explored to reduce the recurrence rate of postoperative adhesion and improve the prognosis.Data and methodsFrom January 2015 to February 2020,166 cases of moderate and severe intrauterine adhesions,94 cases of moderate and 72 cases of severe intrauterine adhesions were diagnosed.According to the operation plan,the patients were divided into 4 groups: group A: cold knife separation + cook balloon,and take out the cook balloon one week after operation.Group B: cold knife separation + IUD.Group C: the cook balloon was removed one week after operation.Group D: single pole electrosurgical separation + IUD.One month after the operation,all patients underwent hysteroscopic exploration again to find out the shape of the uterine cavity and the adhesion of the uterine cavity,and the AFS score was made.One month,two months and three months after operation,the improvement of menstruation was followed up.Result1、Recovery of uterine cavityThe recovery of uterine cavity morphology in patients with moderate intrauterine adhesions was significantly better than that in patients with severe intrauterine adhesions(P < 0.05).Among the patients with moderate and severe intrauterine adhesions,there was a significant difference in the improvement of AFS between the four groups(P < 0.05).The improvement of AFS in group A was significantly higher than that in the other three groups(P < 0.05).2、Recurrence rate of postoperative adhesionThe recurrence rate of moderate intrauterine adhesions was significantly lower than that of severe intrauterine adhesions(P < 0.05).Among the patients with moderate and severe intrauterine adhesions,the recurrence rate of postoperative intrauterine adhesions was significantly different among the four groups(P < 0.05).The recurrence rate of postoperative adhesions was: group a <group B < group C < group D.3、Improvement of menstruationCompared with IUA in different degrees,the effective rate of menstrual improvement in one month,two months and three months after operation showed an increasing trend,with an average monthly growth rate of moderate intrauterine adhesions > severe intrauterine adhesions.At the third month after operation,the improvement of menstruation in patients with moderate adhesions was significantly better than that in patients with severe adhesions(P < 0.05).The effective rate of menstrual improvement in 4 groups with moderate and severe intrauterine adhesions showed an increasing trend at 1,2 and 3 months after operation.The average monthly growth rate was: a group > b group > C group > D group.At the third month after operation,there was a significant difference in the effective rate of menstrual improvement between the four groups(P < 0.05),and the effective rate of menstrual improvement was: a group > b > C group > D group.ConclusionFor patients with moderate and severe intrauterine adhesions,cold knife separation combined with cool balloon can significantly improve the shape of the uterine cavity and menstruation,and reduce the recurrence rate of postoperative adhesions.