Comparison of triangular balloon and metal circular contraceptive device in patients with moderate and severe postoperative intrauterine adhesion
Objective:To compare the efficacy of triangular balloon and metal circular contraceptive device in improving moderate and severe postoperative intrauterine adhesions (IUA), and to analyze their effect on postoperative recurrence.Methods:Eighty-one patients with moderate and severe IUA treated at the Department of Gynecology of Huizhou Municipal Central Hospital from January 2019 to January 2021 were selected. The complete random grouping method was used to divide them into either a study group (41 cases) or a control group (40 cases), and all patients were treated by transcervical resection of adhesion (TCRA) in the hospital. The control group was implanted with metal circular contraceptive device immediately after operation, and the observation group was placed with triangular balloon after operation. Both groups were treated with antibiotics for 2 days and low-dose aspirin and estrogen for 3 months. The American Fertility Association (AFS) scores before operation and 1 month, 2 months, and 3 months after operation were compared between the two groups. Inflammatory factors [tumor necrosis factor (TNF)-α and interleukin (IL)-6] before and 7 days after operation, imaging indexes [endometrial thickness, endometrial volume (EV), internal uterine artery blood flow index (FI), and vascular blood flow index (VFI)] before and 3 months after operation, and the recurrence rate within 6 months after follow-up were also compared between the two groups.Results:The analysis of generalized estimation equation showed that, through the significance test of the fixed effects of intercept term (P＜0.001), group (P＜0.001), time point (P＜0.001), and group time point interaction (P＜0.001), it was found that there were significant differences in AFS scores between the two groups at 1 month, 2 months, and 3 months after operation. The endometrial thickness was higher, EV was larger, and the values of FI and VFI were higher at 3 months after operation compared with those before intervention in both groups. Compared with the control group, the endometrial thickness of the study group was higher, EV was larger, and the values of FI and VFI were higher; the differences were statistically significant (P＜0.05). At 7 days day after operation, the levels of TNF-α and IL-6 in both groups decreased significantly, and the levels in the observation group were significantly lower than those in the control group (P＜0.05). After 6 months of follow-up, the total recurrence in the study group was 31.71%, which was significantly lower than that of the control group (55.00%; P＜0.05).Conclusion:Both triangular balloon and metal circular contraceptive device can reduce the degree of adhesion in patients with moderate and severe postoperative IUA, but the efficacy of triangular balloon is more significant and it can further improve the structure and blood flow of the endometrium, reduce inflammatory reaction, and reduce the risk of recurrence.
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