Application Of Hysteroscopy In Diagnosis And Treatment Of Intrauterine Adhesions
Uterine adhesions are caused by trauma to the uterine uterus during pregnancy or non-pregnancy, resulting in damage to the basal layer of the endometrium and partial or complete occlusion of the uterine cavity, leading to abnormal menstruation, infertility or repeated miscarriage. Hysteroscopy is the gold standard method for diagnosing intrauterine adhesions, and it is also the current effective treatment.
Application of hysteroscopy in diagnosis and treatment of intrauterine adhesions
First of all, we understand the causes of uterine adhesions: under normal circumstances, the front and back walls of the uterine cavity are close to each other, but as long as the endometrium is intact, adhesions will not occur, even if the endometrium is peeled off during the menstrual period, adhesions will not occur. A history of uterine cavity operation, pregnancy and secondary infection have damaged the endometrium, and uterine adhesions can form in severe cases. Regardless of artificial abortion, curettage after drug abortion, or diagnostic curettage, it is possible to damage the basal layer of the endometrium, especially those undergoing surgery in primary hospitals, the curettage is deep, and the concept of sterility is indifferent, and it is easy to cause intrauterine adhesions after surgery. .
Operation method:
The operation time is 3 to 7 days after the menstruation is clean, and the amenorrhea can be at any time after the pregnancy is ruled out. Hysteroscopy under intravenous anesthesia. The patient takes the bladder lithotomy position, routinely disinfects the drape, and exposes the cervix. If the probe is difficult to enter the cervix or has resistance or is obstructed when entering the cervix about 2cm, it indicates that the cervical canal or the internal cervix is adhered. If the probe enters the internal cervix smoothly, it will not enter the uterine cavity again, so as not to affect the result of hysteroscopy. The hysteroscope enters the uterine cavity in the direction of the uterine cavity to check the situation in the uterus. With 5% glucose injection as the uterine dilatation medium, the pressure is generally 10.7 to 16.0 kPa. After diagnosis of intrauterine adhesions, the adhesive tapes are separated or removed under the microscope. Those with denser adhesions completed the operation under B-ultrasound monitoring. Probe the depth of the cervix and uterine cavity, and take a few specimens for pathological examination. During the operation, gentamicin and dexamethasone were given to flush the uterine cavity, and a "T" or "uterine" metal contraceptive device was placed. After the operation, antibiotics were given to prevent infection. Progazal 2 mg was taken orally once a day for 21 days, and oxyprogesterone was added 6 to 8 mg/d in the next 10 days. Artificial cycle treatment was given for 2 to 3 months to prevent uterine cavity recurrence. Adhesion. For those with fertility requirements, take out the intrauterine device for hysteroscopy at 3 months after surgery. If there is adhesion, it needs to be separated again and the fallopian tube is ventilated.
The clinical significance of hysteroscopy in the diagnosis and treatment of intrauterine adhesions: In the past, the diagnosis of intrauterine adhesions was often blindly diagnosed by lipiodol, B-ultrasound, and uterine probes, and the treatment with probe expansion was very poor. Hysteroscopy can make an accurate and reliable diagnosis under direct vision, and estimate the location, range, extent, and tissue type of adhesions. At the same time, treatment can completely separate the intrauterine adhesions and remove the adhesion scar tissue as much as possible. Pathological examination can restore the normal shape of the uterine cavity, and can show bilateral fallopian tube orifices, which can solve the patient's pain in a real sense, and can increase the pregnancy rate for those who have fertility requirements.
