Clinical efficacy analysis of combined diagnosis and treatment of moderate and severe intrauterine adhesions
Objective To explore the effect of transcervical resection of intrauterine adhesion(TCRA)and postoperative combination therapy on patients with moderate and severe intrauterine adhesions(IUA).Methods The clinical data of 32 patients with moderate and severe IUA admitted to Tianjin Meijin Yihe Women and Children's Hospital from January 2022 to April 2023 were collected.All patients underwent TCRA to restore uterine cavity morphology,endometrial tissue biopsy was performed for pathological and CD138 immunohistochemical testing,to evaluate the condition of concurrent chronic endometritis(CE).After surgery,the patients were given the treatment with estrogen and progesterone,supplemented by physical barrier isolation treatment with triangular balloon uterine stent.Two months after surgery,hysteroscopy was performed to evaluate the effectiveness of this combined treatment,as well as the patient's menstrual improvement and pregnancy status.Results The incidence rate of moderate and severe IUA with CE was 40.63％(13/32),and the cure rate was 92.31％(12/13)after oral administration of doxycycline 200 mg/d for 14 days.There were no the occurences of postoperative infections and complications.The effective rate of treatment determined by secondary hysteroscopy examination was 93.75％(30/32).The proportions of significant improvement and no significant improvement in menstrual flow were 78.13％(25/32)and 21.88％(7/32),respectively;after follow-up for 2-15 months,34.38％(11/32)successfully conceived,with a median interval of 5 months between the last hysteroscopy examination.The pregnancy rate after the treatment of moderate and severe IUA combined with CE was 53.85％(7/13).Conclusion TCRA was the standard surgical procedure for the diagnosis and treatment of moderate and severe IUA.Postoperative sequential treatment with estrogen and progesterone,combined with the placement of biological protein glue and physical barrier in the uterine cavity,could effectively prevent uterine re-adhesion,significantly improve menstrual flow and increase postoperative pregnancy rate.
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