Comparison of the effect of hysteroscopic electroresection and mechanical separation in the treatment of moderate to severe intrauterine adhesions / 中国综合临床

ABSTRACT

Objective:To compare the effect and reproductive prognosis of hysteroscopic electroresection of intrauterine adhesions and mechanical separation in the treatment of moderate and severe intrauterine adhesions (IUA).Methods:A retrospective case-control study was conducted to analyze the clinical data of 116 cases of moderate and severe intrauterine adhesions treated by transcervical resection of adhesions(TCRA) in Guangzhou First People′s Hospital from February 2015 to January 2017.According to the different operation methods and condition of the patients, 116 patients were divided into mechanical group (54 cases) and treated with hysteroscopic mechanical separation, including 41 cases of American Fertility Society (AFS) classification of moderate and 13 cases of severe; ; 62 cases of electric resection group were treated with electrosurgical separation, including 47 cases of moderate AFS classification and 15 cases of severe AFS.The operation time, intraoperative bleeding volume, one-time success rate, postoperative cervical morphology, menstrual recovery and pregnancy outcome were compared between the two groups.Results:The operation time of severe patients in mechanical group ((31.56±4.37) min), electrotomy group ((23.73±4.27) min) was longer than that of moderate patients ((27.56±4.37) min and (20.35±4.11) min). The intraoperative bleeding volume in mechanical group ((16.24±4.74) ml) and electrotomy group ((12.56±4.26) ml) was higher than that of moderate patients ((13.87±4.42) ml and (9.57±4.35) ml), the difference was statistically significant (t values were 2.981, 3.214, 3.014, 4.011, P values were 0.005, 0.006, 0.005, <0.001). Meanwhile, the moderate and severe operation time of mechanical group was longer than that of electrosurgical group, and the intraoperative blood output was more than that of electrosurgical group (t values were 5.245, 4.742, 4.591, 4.347, all P<0.001). The total effective rate of uterine cavity morphology was 100% (41/41, 47/47) in the two groups, which was higher than that in the severe group (9 cases in the mechanical group, 10 cases in the electrotomy group, χ 2=12.304, χ 2=15.615, all P<0.001). The total effective rate of menstrual recovery in the mechanical group was 95.12% (39/41) higher than that in the severe group (4 cases), and 78.72% (37/47) in the electrotomy group, (χ 2=14.347, χ 2=5.100, P<0.001, P=0.025). In the electrotomy group, the effect of menstrual recovery was 78.72% (37/45) higher than that in the severe group(5 cases), (χ 2=11.554, P<0.001). The required fertility rate (95.12% (39/41) in the mechanical group, 95.74% (45/47) in the electrosurgical group), the successful pregnancy rate(69.23% (27/41) in the mechanical group, 68.89% (31/47) in the electrosurgical group), the live birth rate (70.37% (19/41) in the mechanical group, 70.97% (22/47) in the electrosurgical group) and the full-term birth rate (51.85% (14/27) in the mechanical group and 51.61% (16/31) in the electrosurgical group) were higher than those in the severe patients (the mechanical group 10 cases, 4 cases, 1 case, 0 case; the electrotomy group 11 cases, 4 cases, 1 case, 0 case, χ 2 values were 4.087, 5.332, 4.111, 3.996, 4.334, 4.658, P values were 0.047, 0.015, 0.042, 0.046, 0.033, 0.027, 0.044, 0.042). The placental adhesion rate during labor (22.22% (6/27) in mechanical group, 22.58% (7/31) in electrosurgical group) and placental implantation rate (7.41 (2/31) in mechanical group and 6.45% (2/35) in electrosurgical group) were lower than those in severe patients (2 cases and 1 case in mechanical group, 2 cases and 1 case in electrosurgical group, P values were 0.043, 0.037, 0.045, 0.04). Conclusion:Hysteroscopic resection of moderate and severe intrauterine adhesions and mechanical separation have good curative effect on moderate and severe IUA patients.The operation mode can be reasonably selected according to the actual situation of the hospital and patients.