Curative effect analysis of three methods in the prevention of adhesion reformation after transcervical resection of adhesion

Abstract

Objective To compare the curative effects of three methods in the prevention of adhesion reformation after transcervical resection of adhesion (TCRA). Methods A total of 495 patients were involved, who were diagnosed as intrauterine adhesions (IUA) by hysteroscopy and received TCRA treatment in the Northwest Women and Children′s Hospital from January 2010 to January 2016. The 495 patients were randomly divided into A, B and C 3 groups by drawing lots. There were 180 IUA patients in group A, who were placed foley catheter ballon combined with absorbable anti-adhesion materials in uterine cavity to prevent adhesion reformation after TCRA. There were 168 IUA patients in group B, who were only placed foley catheter ballon in uterine cavity after TCRA. And there were 147 IUA patients in group C, who were placed intra-uterine device (IUD) in uterine cavity after TCRA. Meanwhile, three groups of patients were treated with estrogen-progestogen sequential therapy to repair endometrium. All patients were followed up after TCRA, and hysteroscopic examination was conducted at the third month after TCRA. Then according to IUA score criteria and the judgment of degree based on the 1988 American Society for Fertility (AFS) on hysteroscopic examination and clinical manifestations of patients with IUA, the IUA situation which included the total scores and the scores of scope of IUA, type of adhesions and menstrual status of three groups of patients, were evaluated again to evaluate efficacy of each method. The following items were statistically compared by the randomized controlled clinical trial: the general situation of patients, the IUA score by AFS and each item′s score before TCRA among three groups were compared. The effective rate, IUA score by AFS and each item′s score at the third month after TCRA among three groups were compared. Informed consent was signed with each patient before this study was implemented. Results ①According to the data collected before TCRA, there were no significant differences among three groups in the general situation of patients′s age, body mass index (BMI), the frequency of artificial termination of pregnancy or curettage, the IUA score by AFS and the each item′s score of scope of IUA, the type of adhesions and menstruation status (P>0.05). ②At the third month after TCRA, the effective rate of group A (88.3%, 159/180) was higher than that of group C(60.5%, 89/147), and the difference was statistically significant (χ2=16.000, P<0.001). ③At the third month after TCRA, the menstruation status score of group A was significantly lower than that of group C, and the difference was statistically significant (P<0.001). The scores of IUA scope, adhesions type and IUA score by AFS of group A were lower than those of group B and C, respectively; similarly, those of group B was lower than those of group C, and all the differences were statistically significant (P<0.05). Conclusions Among these three methods in the prevention of adhesion reformation after TCRA, the placement of the foley catheter ballon combined with absorbable anti-adhesion materials in uterine cavity has better curative effect than the placement of foley catheter ballon or IUD in uterine cavity. Key words: Gynatresia; Intrauterine devices; Comparative study; Female