Ms. Wang was doctor for "secondary infertility".Asked about the medical history, I had done three times before. After the abortion, the menstrual flow was reduced by 1/2. During the diagnosis and treatment of infertility, the B -ultrasound repeatedly prompted that the endometrium was very thin, and it was prompted that there may be "uterine adhesion".What is the uterine cavity adhesion?
Look at a set of data first
Multiple abortion and curettage lead to IUA: 25-30%;
Postpartum curettage leads to IUA: 9-30%;
After miscarriage: 7.7 ～ 30.2%
Among women’s infertility, the incidence of uterine cavity adhesion is 4.8 to 22.0%
Insertual amenorrhea occurs in uterine cavity adhesion: 1.7 ～ 5.1%
Muslim adhesion leads to a decrease in menstrual flow: 75%
IUA after surgery: 62.5%
Severe IUA postoperative pregnancy success rate: 22.5 ～ 33.3%
1. Reasons for uterine cavity adhesion
90%of the uterine cavity adhesion is caused by uterine injury after pregnancy, most of which are endometrial damage caused by artificial abortion, resulting in adhesion.The number of artificial abortion in my country exceeds 13 million/year, ranking first in the world.10%of the uterine cavity adhesion is caused by other uterine cavity operations, such as hysteroscopic surgery or uterine arterial embolism surgery.
The uterus is an organ with a potential gap. Under normal circumstances, the front and rear walls are closely attached but there is no adhesion. This is because the endometrium has a strong regeneration ability under ovarian hormone.Operation, as long as the endometrium base layer is damaged, the opposite endometrium layer is complete, no rough surface is formed, and the endometrium on the damaged area can quickly regenerate and repair the wound, which will not cause adhesion.However, when the surgical operation of the uterine cavity damage the bottom range of the endometrium, the uterine cavity adhesion may be followed by the surgery.
2. Symptoms of uterine adhesion
Patients with adhesion of the uterine cavity are asymptomatic.Depending on the degree of endometrial destruction, amenorrhea may occur or very small menstruation.Those with uterine cavity blood accumulation are manifested as periodic lower abdominal pain.Patients with severe adhesion may have less menstruation or even amenorrhea.Infertility, miscarriage, or abnormal placenta may also occur.
3. Treatment of uterine cavity adhesion
Hysteroscopic separation and adhesion is currently the main method of solving the uterine cavity adhesion:
Usually, the circular electrode is used to cut the adhesion band, or the adhesion is separated by a needle -shaped electrode.Most of the adhesion after hysteroscopy endometrial resection is mostly fibrous muscle tissue adhesion, wide adhesion, and lack of endometrial logo. Therefore, the separation process must be performed under B -ultrasound monitoring to avoid blind separation and cause excessive damage to the uterine muscle wall, resulting in surgery, resulting in surgeryBleeding or uterine perforation.
What needs to be pointed out here is that the purpose of separating the uterine adhesion of TCRE is not to rebuild the uterine cavity, but just to relieve the accumulation of the uterine cavity or effusion and relieve cyclical abdominal pain.The opening site can completely discharge the residual blood accumulation.
If patients have fertility requirements, they need to pay attention to restoring the normal shape of the uterine cavity during the operation to avoid destroying the normal endometrium.
Surgical treatment is the standard treatment of IUA.There is no effective treatment for severe IUA.
1. Infertility of surgical treatment; repeated abortion; low menstrual flow and fertility requirements; pain; uterine cavity accumulation.
2. The purpose of surgical treatment restores the cervix, uterine cavity, and fallopian tubes; solve the relevant symptoms; achieve fertilization and bed.
4. Prevention of uterine cavity adhesion
Prevention is more important than treatment.The cracked focus of uterine adhesion focuses on prevention and prevent unnecessary curetic surgery. What is unnecessary curettage surgery is the flow of people caused by accidental pregnancy. This is the most harmful and the most common cause of uterine adhesion.
After one abortion, 30 % of patients may have uterine cavity adhesion, half of the abortion may occur in the secondary flow, and more than 60 % of patients with more than 60 % of the abortion may occur in the uterine cavity adhesion.
Therefore, before completing fertility, we must scientifically and efficient contraception to avoid harming uterine soil and avoid forming uterine cavity adhesion.Not only to protect women’s precious reproductive resources, but also to protect doctors, reducing these difficult operations and extremely risky surgical operations.
