RESUMO
Objective To assess the effects of absorbable biomedical membrane-embedded intrauterine device ( IUD) in prevention of recurrence after hysteroscopic adhesiolysis for severe intrauterine adhesions ( IUA ) .Methods A prospective study was carried out among 125 patients who underwent hysteroscopic adhesiolysis for severe IUA from February 2013 to January 2015.Foley catheter was placed immediately after surgery and removed 7 days later.Then patients were randomly divided into three groups:group A (40 cases) received round IUD insertion after catheter removal;froup B (41 cases) received IUD placement and intrauterine injection of sodium hyaluronate; group C ( 44 cases ) received absorbable biomedical membrane-embedded IUD insertion.All patients received two artificial cycles ( oral estradiol valerate, 9 mg/d) the first day after surgery.Hysteroscopy was carried out two months later to assess the repair of endometrium.Patients who were cured or whose condition was greatly improved received three-dimensional transvaginal ultrasound examination in the first natural cycle.Thickness of endometrium, uterine volume and blood flow index were compared.Results Cure rate and effective rate in group C were significantly higher than that in groups B and A [43%(19/44) vs.22%(9/41) and 20%(8/40), χ2 =6.89,P=0.03, 86%(37/44) vs.56%(26/41) and 65%(23/40), χ2 =9.78, P =0.01].The improvement rate of menstruation was higher in group C compared with groups B and A [84%(37/44) vs. 63%(26/41)and 58%(23/40),χ2 =7.73, P=0.02].Average endometrium thickness, uterine volume and blood flow index were also significantly improved in Group C[(8.4 ±1.1) vs.(7.2 ±1.5) and (7.6 ± 1.1) mm, F=5.42,P=0.01,(4.3 ±0.3) vs.(3.9 ±0.4) and (4.0 ±0.6) cm3 ,F=7.12,P=0.00, 28.0 ±4.0 vs.24.6 ±4.7 and 23.4 ±4.0,F =5.40,P =0.01] .No significantly differences were observed between group B and group A in terms of the above indices.Conclusion Insertion of absorbable biomedical membrane embedded-IUD has a good therapeutic effect and can better prevent adhesion recurrence in patients with severe intrauterine adhesion after adhesiolysis.
