523 patients with IUA were investigated for 2 ~ 5 cm before operation. It is extremely difficult to probe into the uterine cavity. The cervix needs to be gradually expanded from 3.0mm to 6.5 ~ 7.0 mm before hysteroscopy can be placed in the cervical canal. Look at the shape of the uterine cavity: the uterine cavity is narrow and strip-shaped, with both sides of the uterine cavity, bilateral uterine horns and fallopian tube mouths all disappearing, some uterine cavities are locked, and severe and extensive adhesion makes the uterine cavity completely disappear, and the uterine cavity is covered with white surface without endometrial adhesion, leading to the formation of a solid uterus.
2.2 The shape of uterine cavity after hysteroscopic surgery
Most of the 523 patients with IUA were successfully separated by hysteroscopy once, only 43 cases were separated twice and 7 cases were separated three times. After separation, the depth of uterine cavity was more than 6.0cm, 324 cases (62.0%) recovered to normal, and 172 cases (32.9%) recovered to normal. Hysteroscopy showed that 286 cases (54.7%) returned to normal, 203 cases (38.8%) returned to normal, and 18 cases (3.4%) had severe intrauterine adhesions after operation.
2.3 Menstruation after Hysteroscopic Surgery
Menstruation in the third month after operation: 34 1 case (65.2%) had normal menstruation, 165 cases (3 1.5%) had decreased menstruation, and 18 cases (3.4%) still had amenorrhea.
2.4 Periodic abdominal pain after operation
176 patients with periodic abdominal pain, 156 patients' symptoms disappeared, and 20 patients still had periodic abdominal pain, but it was obviously relieved compared with before hysteroscopy.
2.5 postoperative curative effect
Cured 34 1 case (65.2%), effective 150 cases (28.7%), and the total effective rate was 93.9%. 32 cases were ineffective (6.65438 0%).
2.6 Postoperative pregnancy
Follow-up for 3 ~ 65438 02 months. In 4 17 patients who wanted to have children, hysteroscopic tubal intubation was performed. Results There were 75 cases of bilateral tubal nowhere, 7 cases of hypergalactia and abnormal semen dynamic analysis 1 1 case. Excluding the above 93 cases, 324 cases were corrected, including 47 cases of pregnancy/kloc-0, and the pregnancy rate was 45.4%.
3 discussion
Any factor that damages the endometrium will lead to intrauterine adhesions, and intrauterine manipulation is the most important reason. The reflex spasm of uterine mouth during intrauterine operation makes the exposed damaged parts easy to adhere. If this spasm persists, adhesion may occur. Nerve reflex of uterine isthmus makes endometrium unresponsive to ovarian hormones, leading to amenorrhea. This reflex is reversible, so menstruation can be restored after exploring the uterine cavity, dilating the cervix and releasing the adhesion. The treatment of IUA under TV hysteroscope can enlarge the field of vision, make the image clear, facilitate the observation of tiny lesions in uterine cavity and loosen the adhesion zone. The traditional method is to keep the metal ring for at least 3 months after hysteroscopy to prevent intrauterine adhesion again. Compared with traditional methods, it is effective to continuously place balloon catheter in uterine cavity for 65438 0 weeks after operation. This is because the water-filled balloon plays a barrier role in the uterine cavity, which can effectively separate the front and rear, upper and lower, left and right side walls of the uterus; At the same time, it also serves as a scaffold to repair and proliferate endometrium along the surface of the balloon; Catheter can fully drain the liquid in uterine cavity, which is beneficial to the repair of endometrium and effectively prevents intrauterine adhesions; In addition, intermittent water filling and pressurization can passively separate residual adhesion. In addition, the intrauterine device (IUD) of infertile patients needs to be removed after being placed for a period of time, which undoubtedly increases the pain of patients, and this rule is simple and economical.
Hysteroscopic treatment of IUA is easy to cause uterine injury, and patients often have no rapid changes in vital signs. However, once the diagnosis is made, we should reduce the pressure of uterine dilatation and shorten the operation time as much as possible to avoid excessive dilatation of uterine cervix into abdominal cavity and increase the chance of water poisoning and infection. Postoperative observation should be kept in hospital, and uterine contraction and antibiotics should be used to prevent pelvic infection and promote uterine healing. It can be separated under the monitoring of B-ultrasound, and the IUD should be placed under the monitoring of B-ultrasound. Estrogen and progesterone should be given regularly after operation to promote endometrial repair. The diagnosis is not completely clear. When the tissue is embedded in the uterine wound or the perforation is estimated to be large and the operation is more conducive to restoring the reproductive function of the patient, the uterus should still be repaired by surgery.
When using balloon catheter to treat IUA, we should closely observe the changes of patients' vital signs. If necessary, intramuscular injection of atropine (0.5mg), oxygen infusion at the same time, or chest compressions. When a patient puts a balloon in the uterine cavity to stimulate uterine contraction, causing abdominal distension, abdominal pain or even intolerance, the water in the balloon should be released at this time 1 ~ 2 ml to reduce the stimulation to the uterus. Sodium hyaluronate combined with water-filled balloon placed in uterine cavity can prevent re-adhesion after intrauterine adhesion separation.
In this group, 523 patients with severe IUA were continuously placed with balloon catheter after hysteroscopy. Clinical symptoms improved, most of the uterine cavity morphology recovered, and the pregnancy rate increased. It shows that the continuous placement of balloon catheter in uterine cavity after hysteroscopy is safe and effective in the treatment of IUA, which is worth popularizing.