Comparison of three methods for preventing postoperative re-adhesion of moderate and severe intrauterine adhesions
LI Qin1, LIANG Feimei1, GU Qiaoping2, LV Dongxia1
1. Department of Obstetrics and Gynecology,2. Department of Reproduction, Guangdong Provincial Corps Hospital, Chinese People's Armed Police Force,Guangzhou 510005,China
Abstract：Objective To compare the short-term and long-term clinical effects of the COOK balloon, the intrauterine device (IUD) coated with anti-adhesion membrane and the COOK balloon coated with amniotic membrane against postoperative moderate to severe intrauterine adhesions (IUA).Methods One hundred and nine patients undergoing uterine adhesion surgery at the Department of Obstetrics and Gynecology of Guangdong Provincial Armed Police Headquarters Hospital between December 2015 and February 2020 were selected. According to the methods of preventing postoperative adhesions following hysteroscopy of IUA, these patients were divided into three groups. The COOK balloon was used in group A, the metal ring coated with anti-adhesion membrane in group B, while the COOK balloon coated with amniotic membrane in group C. The three groups were given artificial cycle therapy with Progynova 4 mg/d for a total of 21 d. Progesterone 10 mg/d was added from the tenth day. Hysteroscopy was performed a second time 3 to 7 d after the end of the first menstruation post-operatively. One month after operation, the COOK balloon was removed in group A, IUDs in group B, while hysteroscopy was performed in group C. The recovery of the uterine cavity and menstruation was observed and compared. Intrauterine adhesions one month and three months after operation was compared between the three groups. Post-operative complications and the pregnancy rate one year after operation were also compared between the three groups. Three months after operation, patients whose ultrasound showed intrauterine adhesions and menstrual volume was significantly reduced were r-examined with hysteroscopy.Results The total effective rate of the recovery of the uterine cavity morphology was similar across the three groups. Three months later, the incidence of intrauterine adhesions in group A and group C was significantly lower than in group B (P<0.05). There was no significant difference in the pregnancy rate between the three groups (P<0.01). However, there were 2 cases of abdominal pain and irregular vaginal bleeding in group A, 19 cases of incarceration of IUDs, 10 cases of low back pain and 7 cases of irregular vaginal in bleeding group B. After IUDs were removed, the symptoms were relieved.Conclusions The short-term effect of the three approaches to prevention of post-operative intrauterine adhesions is similar, but IUDs are likely to cause complications, and are not quite effective for long-term postoperative prevention of intrauterine adhesions. The COOK balloon and amniotic membrane are clinically more applicable.
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