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Objective To explore the differences of different clinical indicators between patients with severe and non-severe intrauterine adhesions （IUA）. Methods Clinical data of 118 patients with IUA diagnosed by hysteroscopy were analyzed retrospectively. According to the AFS scoring standard of IUA, all patients were divided into the severe IUA group （severe group） and mild-moderate IUA group （non-severe group）, and the differences of different clinical indicators between two groups were analyzed. Results Compared with the patients in the non-severe group, the patients in the severe group had more pregnancies, more than two times of uterine curettage, and more times of hysteroscopic resection （all P < 0.05）. There were statistically significant differences between the severe and non-severe groups after induced abortion, hysteroscopic resection, and uterine artery embolization combined with curettage （all P < 0.05）. Among the patients undergoing different times of uterine cavity operations, the difference between the severe and non-severe groups was statistically significant. Compared with the 1-time and 2-time uterine cavity operation groups, the proportion of severe group （85%） in the ≥3-time uterine cavity operation was significantly increased （both P < 0.05）. In the severe group, the proportion of abnormal uterine cavity （heterogenous echoes, continuous interruption, unclear display or adhesion） revealed by transvaginal color Doppler ultrasound was significantly higher than that in the non-severe group （P < 0.05）. Conclusions Induced abortion, hysteroscopic electrosurgery and uterine curettage after uterine artery embolization can increase the risk of IUA. Transvaginal color Doppler ultrasound has good diagnostic value for severe IUA.

Objective To compare the clinical efficacy of different adjuvant treatment schemes for patients with moderate to severe intrauterine adhesions after hysteroscopic transcervical resection of adhesion (TCRA). Methods Clinical data of 98 patients with moderate to severe intrauterine adhesions were retrospectively analyzed. All patients underwent hysteroscopic TCRA for intrauterine adhesions. According to the adjuvant treatment schemes, all patients were divided into the TCRA group (group A, n =17), TCRA+balloon stenting group (group B, n = 35) and TCRA+balloon stenting+intrauterine injection of sodium hyaluronate group (group C, n=46). Postoperatively, all patients received artificial cycle treatment. At postoperative 1 month, hysteroscopy was performed to evaluate the severity of intrauterine adhesions. The American Fertility Society (AFS) scores of all patients were recorded before and after surgery. The changes of menstrual volume at postoperative 3 months were observed in three groups. Results The differences of pre-TCRA AFS scores in 3 groups were not statistically significant (P > 0.05). Hysteroscopy at postoperative 1 month found statistical significance in the AFS scores among three groups (P < 0.05), and the AFS score in group C was significantly lower than those in groups A and B (both P < 0.05). There was significant difference in the changes of menstrual volume among three groups at postoperative 3 months (all P < 0.05). The effective rates of menstrual volume improvement were 41%(7/17), 63%(22/35) and 91%(42/46) in groups A, B and C, and the differences were statistically significant (all P < 0.05). The effective rate of menstrual volume improvement in group C was significantly higher compared with those in groups A and B (both P < 0.017). Conclusion TCRA combined with intraoperative intrauterine placement of balloon stent, sodium hyaluronate and postoperative artificial cycle treatment yield high clinical efficacy for moderate to severe intrauterine adhesions and accelerate postoperative recovery.