Prevention of recurrent adhesion after separation of severe intrauterine adhesions

Abstract

Objective To investigate the effect of regular hysteroscopy examination on preventing the recurrent adhesion after the separation of severe intrauterine adhesion.Methods The clinical data of 37 patients with severe intrauterine adhesion underwent transcervical resection of adhesions (TCRA) were analyzed retrospectively.They were divided into two groups according to different preventive methods after surgery.Twenty- one cases in group A were given balloon urinary catheter in the uterine 3 to 4 days after surgery,and then pla ced a intrauterine device ( IUD),together with estrogen and progesterone to establish artificial cycle.Sixteen cases in group B were given the same treatment as group A,and were reviewed by hysteroscopy regularly.All the patients were followed by the examination of menstrual recovery in three months after operation and were reviewed by hysteroscopy at the third month what time the IUD were taken out.The patients who had moderate to severe intrauterine adhesion again were categorized as group C,and were given adhesiotomy again and the same treatment as group B,the conditions of intrauterine adhesion and menstrual recovery were recorded.Results Three months' follow up showed that the rate of recurrent intrauterine adhesion in group B was significantly lower than that in group A ( P ＜ 0.05 ),and the menstrual quantity in group B was also improved obviously (P ＜ 0.05 ).The rates of recurrent intrauterine adhesion of the two groups were as follows:57.14％ ( 12/21 ) in group A,12.50％ (2/16) in group B.The proportions of recurrent moderate to severe intrauterine adhesion were as follows:42.86％ in group A(9/21,6 cases of moderate adhesion and 3 cases of severe adhesion),6.25％ in group B( 1/16,1 case of moderate adhesion).The improvement rates of menstrual quantity were as follows:57.14％ ( 12/21 ) in group A and with 87.50％ (14/16) in group B.Six months after operation,there were 2 cases with mild adhesion and 2 cases with moderate adhesion in group C,7 cases had improvement of menstrual quantity.No kidney or liver function abnomality has been found in all of the patients.Conclusions After postoperative separation of severe intrauterine adhesion,regular hysteroscopy examination on the basis of putting a balloon urinary catheter and IUD combined with estrogen can effectively prevent the recurrence of adhesion and improve the menstrual recovery. Key words: Intrauterine adhesions; Hysteroscopy ; Transcervical resection of adhesions; Estradiol valerate