Application of non-cervical dilation hysteroscopic technique versus HEOS hysteroscopic technique in intrauterine adhesion separation

Objective To investigate the application value of different hysteroscopic techniques in the treatment of intrauterine adhesions (IUA) and their effects on vascularfunction indicators.

Methods A total of 102 patients with IUA from June 2021 to December 2022 were selected as study subjects and divided into two groups based on the random number table method, with 51 patients in each group. Both groups underwent hysteroscopic cold knife adhesiolysis. The observation group adopted non-cervical dilation hysteroscopic technique, while the control group adopted HEOS hysteroscopic technique. Surgical-related indicators, surgical efficacy, menstrual improvement as well as stress response before and after surgery, vascular function-related factors, and endometrial blood flow were observed in both groups. Postoperative complications, recurrence, and clinical pregnancy within 1-year follow-up were also recorded.

Results The operative time in the observation group was shorter, and the intraoperative blood loss was less than that in the control group (P < 0.05). There was no statistically significant difference in the total effective rate of surgical treatment between the observation group and the control group (P>0.05). The total improvement rate of menstruation in the observation group was higher than that in the control group(P < 0.05). Levels of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) increased at 24 hours after surgery and decreased at 48 hours after surgery compared with levels at 24 hours after surgery in both groups. Additionally, the observation group had lower levels than the control group at 24 and 48 h after surgery (P < 0.05). At 1- and 3-month after surgery, serum hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels decreased compared with pre-surgery levels in both groups, with the observation group showing lower levels than the control group (P < 0.05). At 1- and 3-month after surgery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) increased compared with pre-surgery levels in both groups, with the observation group showing higher levels than the control group (P < 0.05). The clinical pregnancy rate at 1-year follow-up in the observation group was higher than that in the control group (P < 0.05).

Conclusion Both non-cervical dilation hysteroscopic technique and HEOS hysteroscopic technique have good clinical effects and safety in the treatment of moderate IUA, but the former can optimize the operation process, reduce perioperative stress response, and improve patients' hemodynamics and menstrual status.