Hysteroscopic adhesiolysis

There are many kinds of gynecological diseases in women, some of which are caused by external factors and some are caused by the uterus. Cervical erosion is a serious uterine disease, and cervical adhesion is particularly prone to occur before cervical erosion. When women have cervical adhesion, they will not only feel pain during sexual intercourse, but may also cause interference with their menstrual period, so they must be separated quickly. So what is the principle of hysteroscopic uterine adhesion separation surgery?

90% of intrauterine adhesions occur after miscarriage or curettage. Excessive curettage can damage the basal layer of the endometrium, causing intrauterine adhesions. Secondary infection based on the damage is more likely to cause adhesions. Endometrial tuberculosis is also the main cause of intrauterine adhesions. In severe cases, complete adhesions can cause amenorrhea.

The typical symptoms of intrauterine adhesions are menstrual abnormalities and reproductive dysfunction. Menstrual abnormalities are mainly manifested as decreased menstrual volume or amenorrhea. When the adhesion site is in the cervical canal or internal os, amenorrhea often occurs accompanied by periodic lower abdominal pain. Intrauterine adhesions are mild, the adhesion range is small and sparse, and the menstrual changes are not obvious, which is easy to be neglected. It is mostly because of the discovery of uterine cavity filling defect during hysterosalpingography for infertility, and then hysteroscopy is performed to confirm the diagnosis. According to the location of adhesion, it can be divided into three categories: simple cervical adhesion, intrauterine adhesion and cervical intrauterine adhesion.

Hysteroscopy has the dual functions of inspection and treatment. It can not only determine the location, range and tissue type of adhesions, but also accurately and completely separate adhesions to restore the uterine cavity morphology, prevent re-adhesion after separation, and promote the repair of damaged endometrium.

For simple adhesions of the internal opening of the cervical canal, only dilation with a Heiger device is required, and Vaseline gauze can be placed to prevent re-adhesion. For those with adhesions in the cervical canal and uterine cavity, they must first be carefully explored and dilated with a dilator until the hysteroscope can be inserted. Simple endometrial adhesions can be separated by uterine distension pressure or the top of the hysteroscope, while dense adhesions require biopsy forceps and micro-scissors to tear and cut the adhesion bands. Adhesions in the central area can usually be separated using this method, while adhesions at the edges are mostly composed of muscular tissue.

Generally, intrauterine adhesions can be separated smoothly by hysteroscopy, but in the following situations, simultaneous monitoring with laparoscopy, i.e., combined hysteroscopy and laparoscopy, should be considered.

1) Severe adhesion of the posterior uterine wall and closure of the fallopian tube opening;

2) After separating some adhesions, the uterine horns and fallopian tube openings are still not visible;

3) Hysterosalpingography indicates venous reflux around the uterus or fallopian tube obstruction;

4) Even a thin needle cannot penetrate into the uterine cavity.

The standard for complete separation of intrauterine adhesions is that the entire uterine cavity returns to its normal size and shape, and the openings of the bilateral fallopian tubes are clearly displayed. After completing laparoscopic separation of intrauterine adhesions, you must follow the doctor's instructions carefully to facilitate postoperative recovery and improve the effective pregnancy rate.