ABSTRACT
Objeetive To evaluate the efficacy of moderate and severe intrauterine adhesion (IUA) following uterine arterial embolization (UAE) after hysteroscopic adhesiolysis.Methods A analysis of clinical efficacyl was performed.According to American Fertility Society (AFS) scoring system,60 cases following UAE were used for the observation group,60 cases without following UAE were used for the control group.Hysteroscopic adhesiolysis was performed in two groups.Second-look hysteroscopic examination was performed to all patients at 3 months postoperatively for evaluation of IUA.Primary endpoint was the reduction rate of IUA at 3months afer hysteroscopic adhesiolysis.The secondary endpoint includes total AFS score,and score of each individual AFS category.Results At 3 months after surgery,the observasion group resulted in significantly lower effective rate for reduction of adhesion,the effctive rate were 37.04％ (20/54) and 82.46％ (47/57) (P ＜ 0.05);the tatal AFS score of the observation group (6.06 ± 3.18),and significantly lower than that of the control group (3.88 ±3.01,P ＜0.05),meanwhile,with regard to their adhension area,adhension type,menstrual pattern,the score of the observation group (1.78 ± 1.37,2.50 ± 1.51,1.78 ± 0.74),and significantly lower than that of the control group (1.12 ± 0.93,1.89 ± 1.51,0.86 ±0.99) (P =0.004,0.037,0.01).The observation group had singnificantly lower proportion than that of the control group (P ＜ 0.05).Conclusions The women with moderate and severe intrauterine adhesion following UAE had singnificantly the lower effective rate for reduction of adhesion,the higher rate of re adhesion and the poorer outcome of regerenation after hysteroscopic adhesiolysis.Gynecologist strictly grasps indications of uterine arterial embolization.
ABSTRACT
Objective To investigate the effects on retained placenta and membrane patients who complete curettage of uterine cavity with the hysteroscopy when injecting oxytocin in the cervix before operation and shorting the time of single expanding uterus.Methods Totally 147 patients at the Maternal and Child Health Hospital of Hunan Province were divided into the intervention group (72 cases) and control group (75cases).The intervention group was injected 10u oxytocin in the cervix before hysteroscopy and curettage of uterine cavity,all at once,controlling the time of single expanding uterus (no more than 5 minutes).The control group was not injected oxytocin before hysteroscopy and curettage of uterine cavity,and not limited the time of single expanding uterus (5 minutes to 10 minutes).A series of parameters were compared among two groups,including total expansion uterine time,mean single expansion uterine time,operation time,frequency of hysteroscopy,the amount of bleeding,hemoglobin decline,hemostatic measures use rate,postoperative infection rate,the rate of the second time curettage,and incidence of intrauterine adhesions.Results Compared to the control group,total expansion uterine time,mean single expansion uterine time,and operation time were significantly shorter in the intervention group;at the same time,the amount of bleeding,other hemostatic measure use rate,and incidence of intrauterine adhesions were significantly less in the intervention group (P ＜ 0.05).On the other hand,frequency of hysteroscopy,postoperative infection rate,the rate of second time curettage were not more (P ＞ 0.05).Conclusions Not only the time of operation and the amount of bleeding are decreased but also postoperative infection rate and incidence of intrauterine adhesions are decreased when injecting oxytocin before hysteroscopy and shorting the time of single Expanding uterus.In other words,this method can keep clear vision of operation under direct vision,avoid repeated curettage,tissue trauma,decrease incidence of intrauterine adhesions,increase operative successful rate,and keep healthy and reproductive capacity of patients.Therefore,it is worth promoting.