How to perform surgery for intrauterine adhesions

Many women are required to undergo hysteroscopic transurethral resection due to intrauterine adhesions. Due to information asymmetry, many patients are anxious. Medical staff yiwuzhe.com here explains the surgical process of hysteroscopic transurethral resection in detail to eliminate patients' anxiety and anxiety. So, how to perform surgical treatment for intrauterine adhesions?

When there are adhesions in the uterine cavity, they need to be removed surgically. There are two situations. For mild adhesions, it can be treated in the hospital, that is, hysteroscopic adhesion separation surgery. After the separation surgery is completed, you should take drugs to restore the shape of the uterus according to the doctor's instructions, such as artificial period conditioning Bujiale plus progesterone copper, or short-acting drugs. After taking it for three months, go back to the hospital for a follow-up B-ultrasound. If there are solid adhesions, hospitalization is required for hysteroscopic adhesion resection surgery. At this time, surgery is required to separate the adhesions and restore them to a normal uterine cavity shape. You can also insert an IUD into the uterine cavity after surgery to prevent the possibility of adhesions occurring again. You should also take medicine as prescribed by your doctor to restore your menstrual period and repair the endometrium to avoid repeated menstrual irregularities.

Hysteroscopic transurethral resection of intrauterine adhesions

(1) Fill the bladder, carefully place the probe under the correct guidance of B-mode ultrasound, and use Hegar dilators to gradually dilate the cervix and uterine cavity. When the probe cannot reach the fundus of the uterus or only probes into the cervical canal due to intrauterine lock, the laparoscopic surgery can be performed later, or the probe can be moved forward along the center line of the cervix and uterus to probe the fundus under the monitoring of B-mode ultrasound.

(2) Under the correct guidance of ultrasound, the hysteroscope is inserted into the uterine cavity along the external cervical os and cervical canal. Check the shape of the cervical canal and uterine cavity, observe the bilateral uterine horns and bilateral fallopian tube openings, reveal adhesion tissue, and determine the location and level of adhesion.

(3) The high-density adhesion scar tissue in the cervical canal can be cut open with an intrauterine argon knife fiber electrode or removed with a ring electrode (Figure 7-3).

(4) The membranous or fibrous adhesion tissue in the center of the uterine cavity can be removed by hysteroscopic fibrous electrode cutting or circular electrode electroresection (Figure 7-4A, B). The normal uterine wall needs to be maintained during the operation.

(5) For adhesion scar tissue on the anterior, posterior and outer walls of the uterine cavity, fibrous electrodes can be used to cut them open along the short axis of the uterus, and circular electrodes can be used to remove them if necessary.

(6) Adhesions in the fundus and uterine cornu should be cut horizontally with a fibrous electrode or wildly with a circular electrode to completely open the fundus (Figure 7-7A, B). In addition, the laser cutting moves towards the uterine cornu, opening both sides of the uterine cornu as much as possible to expose the openings of both fallopian tubes. Generally, under B-mode ultrasound monitoring, fiber electrodes are used to separate the adhesions at the uterine angles, and circular electrodes are used to cut the adhesion tissue when necessary, gradually revealing the uterine angles and bilateral fallopian tube openings, restoring the normal shape of both uterine angles (Figure 7-8A~F). Pay special attention to maintaining normal endometrial tissue in the uterine cornu.

(7) For patients with endometrial scar muscle spasm causing uterine cavity narrowing, fibrous electrodes can be used to cut 4 to 5 radial lines of scar tissue vertically along the short axis of the uterus to expand the volume of the uterine cavity (Figures 7-9).

(8) If the uterine cavity is closed and the front of the endoscope is blind, under the monitoring of B-ultrasound, a fibrous electrode or a ring electrode can be used to gently push forward along the center line of the cervix and uterus to try to open the adhesions and cut out the porosity to reveal the uterine cavity (Figure 7-10A~C). Then, the intrauterine adhesions are removed according to the above process and the intrauterine shape is restored (Figure 7-10D).

(10) If there is a laparoscopic surgeon, a methylene blue aqueous solution can be introduced into the uterine cavity to perform a bilateral fallopian tube patency test and observe the patency of both fallopian tubes during laparoscopic surgery.

Hysteroscopic scissors separation method for intrauterine adhesions:

(1) Hysteroscopic surgery is preferred. Insert an intrahysteroscope to observe the shape of the uterine cavity and the condition of intrauterine adhesions. (2) Insert the flexible semi-rigid scissors or rigid scissors into the uterine cavity along the operating channel of the intrahysteroscope. (3) Use hysteroscopic scissors to slowly separate adhesions from the center of the uterine cavity to the surrounding areas to expand the uterine cavity. If adhesions are common, pay special attention to the depth of adhesion separation to be alert to uterine perforation. When separated to the bus station, under the guidance of B-mode ultrasound, the mineral acid was removed from the uterine cornu as much as possible to expose the openings of both fallopian tubes. (4) When the uterine cavity or cervical canal is completely closed, it should start from the bottom of the adhesion and gradually separate along the center line of the uterus under the guidance of B-mode ultrasound until a new uterine cavity is opened.