Because this disease is affected by hormones, hormone therapy is mainly used, and surgery is used when hormone therapy is ineffective or the condition is serious. Although these methods have certain therapeutic effects, the recurrence rate is high and the long-term curative effect is not ideal.
First, regular follow-up:
If the patient is in the early stage of endometriosis and the symptoms are mild or asymptomatic, temporary observation and regular follow-up can be carried out, and infertility can be encouraged to get pregnant, and the symptoms often disappear after pregnancy and delivery. During the follow-up, if the condition worsens, other methods should be used for treatment.
Second, hormone therapy.
1. Androgen; It has special effects on dysmenorrhea caused by endometriosis. Methyltestosterone 5mg, orally twice a day; Or testosterone propionate 25mg, intramuscular injection, twice a week, after 2 ~ 3 months, the drug was stopped for observation. The monthly dose should not exceed 300 mg. Otherwise, there may be masculine performance.
2. Pseudopregnancy therapy: that is, oral contraceptives cause artificial amenorrhea similar to pregnancy. Commonly used drugs include progesterone acetate, progesterone, megestrol acetate and norethindrone 18, all of which can be used to treat this disease. Generally, the commonly used dosage is more than 4 times of contraceptive dosage, supplemented by a certain amount of estrogen, and ethinyl estradiol is commonly used to prevent endometrial shedding and bleeding. Once breakthrough bleeding occurs, the dose of estrogen can be increased. Generally speaking, it is recommended to give it continuously for 6 ~ 12 months.
3. Pseudomenopause therapy: It is the most effective method to treat endometriosis at present. Take danazol orally 400 ~ 800mg/ day, divided into 2 ~ 4 times, generally starting from the fifth day of menstruation, and gradually reducing it to 200mg/ day after amenorrhea, with a course of 6 months.
4. Sodium methoxynapropionate: It is an inhibitor of prostaglandin synthesis and is suitable for patients with obvious dysmenorrhea but slight signs or not suitable for surgery and hormone therapy. Its usage is to take 2 tablets of sodium methoxynapropionate (275mg each) orally during dysmenorrhea, and then take 1 tablet every 4-6 hours according to the situation for 3-5 days. Generally, there are no obvious side effects, and a few of them may have symptoms such as fatigue, mild headache and chest pain.
5. Tamoxifen (TMX): a synthetic non-steroidal anti-estrogen drug. The usual dose is 10mg, twice a day for 6 months. Ovulation was not inhibited, and serum LH and FSH did not change. It can get pregnant during treatment. Animal experiments show that it has no teratogenic effect, few side effects and low price, but its effect is not as good as that of danazol, and it recurs quickly after stopping taking medicine.
6. Gestrinone: It is an anti-estrogen drug with a dose of 2.5mg twice a week, starting from the first week of the cycle and lasting for 6 months. If amenorrhea does not appear 1 month after treatment, increase the dose, with a dose of 2.5mg twice a week, and the menstruation will recover in an average of 33 days after drug withdrawal. The side effects are few and mild, and the liver function is not affected, and the fertility recovery is similar to that of danazol.
7.GnRH agonist: It can inhibit gonadal hormone secretion and ectopic endometrial growth. There are two kinds of nasal inhalation and subcutaneous injection implantation. The dosage is 300ug three times a day for * * * 6 months, subcutaneous injection 1 time every 6 weeks, 6.6mg each time, ***3 times, and subcutaneous implantation is more effective. The side effects are various symptoms caused by low estrogen.
Third, surgical treatment.
The main purpose of the operation is to relieve pain, clear pelvic mass, treat infertility and cure endometriosis. According to different conditions and purposes, different surgical methods are selected.
1. Conservative surgery: including open surgery and laparoscopic surgery. The scope of operation includes pelvic adhesion separation, pelvic lesion electrocautery or resection, uterine suspension, ovarian endometriosis cyst removal, and simultaneous resection with hysteromyoma. For those with severe dysmenorrhea, resection of presacral nerve is advocated. Keep normal ovarian tissue as much as possible during the operation. Suitable for young patients with persistent infertility, when conservative treatment fails, or severe dysmenorrhea, drugs can not relieve. The pregnancy rate after operation was 40 ~ 60%. Postoperative recurrence rate is high, and some patients often need reoperation.
2. Semi-conservative surgery: mainly to remove uterine and endometriosis lesions and preserve ovarian function. It is suitable for people under 45 years old who have no fertility requirements, or who have a wide range of lesions and cannot retain their fertility function, or who are complicated with hysteromyoma or adenomyosis. The postoperative recurrence rate is low, only 2 ~ 3%.
3. Radical surgery: total hysterectomy and bilateral appendectomy without preserving ovarian function. If the adhesion is serious and it is difficult to perform total hysterectomy, subtotal hysterectomy or only bilateral oophorectomy can be performed. Suitable for people close to menopause, or people who are seriously ill at a young age. The incidence of menopausal syndrome after operation is high, and low dose estrogen can be given to those with severe symptoms. When the drug recurs, it should be stopped in time.
Key points of prevention and control
The best treatment should be selected according to the patient's age, clinical manifestations, lesion location, scope and fertility requirements. In principle, for young patients with fertility requirements, medical treatment should be considered more, and ovarian and reproductive functions should be preserved as much as possible.
Drug treatment includes: ① pseudopregnancy treatment: the treatment of pseudopregnancy caused by high-dose steroid drugs containing estrogen and progesterone. Ectopic endometrium is transformed into decidua, and then decidua is necrotic, absorbed and subsided. According to Kistner, taking norethindrone 5mg and ethinylestradiol 0.075mg every day has good curative effect and mild adverse reactions. After 6- 12 months of continuous medication, the symptoms were obviously relieved, and the skin lesions were reduced or disappeared. Some patients may relapse after stopping taking drugs. Ovulation function can be restored in a short time after treatment. The pregnancy rate after treatment is 30%-43%, which is suitable for young patients with mild illness who require delivery and patients with postoperative symptoms recurrence. ② Pseudomenopause therapy: Danazol, a synthetic derivative of 17-α- acetyltestosterone, was used. The androgen effect of this drug is weak, which inhibits the release of gonadotropin, directly affects the production of ovarian steroid hormones, reduces estrogen in the body, inhibits the growth of endometrium, and causes amenorrhea in patients, but its FSH and LH are low rather than high, so it is also called pseudo-menopause therapy. Domoski reported that the pregnancy rate was 72%, the symptoms were relieved 100% and the signs were improved by 85%. After drug withdrawal 15% 30% recurred. The usual dosage is 400-800 mg per day, taken orally for 2-4 times, starting from the fifth day of menstruation and lasting for 3-6 months. Ovulation can be resumed within a few weeks after drug withdrawal. Its adverse reactions include hot flashes, sweating, acne, edema and weight gain. Others add SGPT, which is related to the chemical structure of the drug, causing cholestasis, which can be recovered after stopping the drug. Danazol is effective in the treatment of endometriosis, with mild adverse reactions, such as hysteromyoma, which can also promote its atrophy, but it is expensive and difficult to be widely used. ③ Drug-induced ovariectomy: Long-acting gonadotropin-releasing hormone analogue (long-acting GnRH-α) was used. The effect of the drug is to obviously inhibit the FSH level and reduce the secretion of ovarian estrogen. Meldrum reported that GnRH-α 100μg, 1 time //dx28d were injected subcutaneously from the 5th day of menstruation. After one month of treatment, the serum estradiol decreased significantly, similar to that of patients with ovariectomy. The patient's symptoms improved during the treatment, and her menstruation recovered after one week of drug withdrawal. Long-term treatment is similar to ovariectomy, and it is a relatively certain method to treat endometriosis at present.
Surgical treatment: ① Conservative surgery: suitable for young patients who require delivery. The scope of operation includes pelvic adhesion separation, electrocautery or resection of pelvic lesions, uterine suspension, ovarian endometriosis cyst stripping and so on. If the operation fails to completely remove the focus, drug treatment should be given for 3-4 months after operation. The pregnancy rate after conservative surgery is 40%-60%. ② Semi-conservative surgery: For younger people who have no fertility requirements or need hysterectomy, semi-conservative surgery should be performed as far as possible to preserve normal ovarian tissue on one or both sides to avoid menopausal syndrome after operation. ③ Radical surgery: If the patient is seriously ill and older, total hysterectomy and appendectomy are feasible and can achieve the goal of radical cure. If the adhesion is serious and it is difficult to remove the uterus, subtotal hysterectomy or only bilateral oophorectomy can be performed.
TCM treatment based on syndrome differentiation;
1. Qi stagnation and blood stasis
Indications: Premenstrual or menstrual abdominal distension, pain, refusal to press, unsmooth menstruation, lump, pain relief after blood clot discharge, or infertility, premenstrual breast pain, hypochondriac pain, depression or irritability, dark purple tongue or petechia, thin or slippery pulse.
Treatment: soothing the liver and regulating qi, promoting blood circulation and removing blood stasis.
Prescription: Gexia Zhuyu Decoction. 20g of Angelica sinensis, Radix Paeoniae Rubra 15g, Rhizoma Chuanxiong 10g, Semen Persicae 15g, Flos Carthami 15g, Fructus Aurantii 15g, Rhizoma Corydalis 15g, Oletum Trogopterori 15g, etc. If qi stagnation is dominant, the swelling is more than the pain, Toosendan Fructus15g; Added; Blood stasis is dominant, and the pain is more than abdominal distension. Adding Pollen Typhae 15g, 20g of Oletum Trogopterori was reused. For severe pain, add 3 scorpions, Rhizoma Sparganii 15g, Rhizoma Curcumae15g; There are Sanguis Draxonis 15g, Squama Manis 15g, Gleditsia sinensis 20g, Rhizoma Sparganii 15g, and Rhizoma Curcumae 15g. Menstrual volume, plus pollen typhae 15g, madder 159, notoginseng 10g.
2. Cold coagulation and blood stasis
Main symptoms: cold pain in the lower abdomen before or during menstruation, reduction of heat pain, scanty menstrual flow, dark and lumpy color, reduction of pain under lump, chills, pale face, nausea or infertility, dark tongue, white fur and tight pulse.
Treatment: Warming channels and dispelling cold, promoting blood circulation and removing blood stasis.
Prescription: Shaofu Zhuyu Decoction. Fennel 15g, dried ginger 15g, corydalis yanhusuo 15g, Oletum Trogopterori 15g, Myrrha 15g, Chuanxiong 10g, Angelica 20g, Pollen Typhae 15g. For patients with severe abdominal pain, add Zanthoxylum bungeanum 15g, Radix Aconiti Preparata 10g and Radix Aconiti Kusnezoffii Preparata10g; Ginseng 15g, Radix Aconiti Lateralis 15g and Herba Epimedii 20g are suitable for patients with yang deficiency and internal cold. Rhizoma Atractylodis 15g, Pericarpium Citri Tangerinae 10g, Herba Lycopi 15g, and Poria 20g are added for patients with severe damp pathogen, chest distress and abdominal distension, and white greasy tongue coating.
3. Qi deficiency and blood stasis
Main symptoms: abdominal pain during or after menstrual period, feeling warm when pressing, anal dilatation, constipation, listlessness, dull complexion, more or less menstrual flow, dark mass, fat tongue, purple tongue or petechiae, thin white fur and weak pulse.
Treatment: Yiqi Buyang, Huoxue Quyu.
Prescription: Buyanghuanwu Decoction. Radix Astragali 30g, Radix Angelicae Sinensis 20g, Radix Paeoniae Rubra 15g, Lumbricus 20g, Rhizoma Chuanxiong 10g, Semen Persicae 15g, and Flos Carthami 15g. Those who sweat and are afraid of the cold should be added with hanging skill 15g, and Paeonia lactiflora15g; For patients with severe abdominal pain, Artemisia argyi 15g, fennel 15g, frankincense 15g and myrrh15g are added; For nausea and vomiting, Evodia rutaecarpa 15g, Zingiberis Rhizoma 10g and Jiang Banxia10g are added; Add nutmeg 15g, fenugreek 15g and psoralea corylifolia 20g into the loose stool.
4. Heat stagnation and blood stasis
Certificate of entrustment; Fever, abdominal pain, refusal to press before or during menstruation, and even high fever during menstruation until the menstrual temperature gradually returns to normal. The menstrual color is dark red, thick and lumpy, the cycle is advanced or the menstrual period is prolonged, with a large amount, bitter mouth and dry throat, irritability, dry stool, sexual intercourse pain, red tongue, or petechiae on the edge, ecchymosis, yellow fur and rapid pulse.
Treatment: clearing away heat and nourishing, promoting blood circulation and removing blood stasis.
Prescription: Xuefu Zhuyu Decoction. Peach kernel 15g, safflower 15g, angelica 20g, radix rehmanniae 30g, radix paeoniae rubra 20g, rhizoma chuanxiong 10g, radix bupleuri 10g, fructus aurantii 10g, achyranthes bidentata 10g, and licorice/kloc-. Scutellaria baicalensis Georgi 15g and Artemisia annua15g are added for menstrual fever; Dry stool increased yellow 15g and immature bitter orange10g; ; For patients with abdominal pain, 20 g of Houttuynia cordata Thunb, 0/5g of Eupolyphaga Seu Steleophaga/KLOC-0 and 0/5g of Oletum Trogopterori/KLOC-0 are added; Bitter mouth and dry throat, gardenia 15g and scutellaria baicalensis 15g can be added for irritable patients.
5. Kidney deficiency and blood stasis
Main symptoms: abdominal pain during or after menstruation, backache, more or less menstrual flow or blood clots, infertility, dizziness, false stool, frequent urination, pale tongue or petechiae, thin and white tongue coating, heavy and thin pulse.
Treatment: Tonifying kidney and regulating menstruation, promoting blood circulation and removing blood stasis.
Prescription: Guishen Pill, Taohong Siwu Decoction. 20g of Radix Rehmanniae Preparata, 20g of Rhizoma Dioscoreae, 20g of Cornus officinalis 15g, 20g of Poria, 20g of Radix Angelicae Sinensis, 20g of Fructus Lycii, 20g of Eucommiae Cortex 15g, 25g of Semen Cuscutae, 20g of Semen Persicae 15g, Flos Carthami 15g, Rhizoma Chuanxiong 10g and Radix Paeoniae Alba. 20g of epimedium, 0/5g of mistletoe/kloc-and 0/5g of Rhizoma cibotii/kloc-are added for patients with severe lumbago; 20 grams of Psoralea corylifolia and 20 grams of halloysitum rubrum are added to the fake stool.
Prescription:
1. ectopic powder: earthworm, Eupolyphaga Seu Steleophaga, scale insect, centipede, leech, etc., ground into powder, bottled or encapsulated, 2-3g each time, 2-3 times a day. Suitable for endometriosis, combined with oral medication.
2. Prescriptions for promoting blood circulation and removing blood stasis: Rhizoma Sparganii 15g, Rhizoma Curcumae 15g, Pollen Typhae 12g, Oletum Trogopterori 12g, and Semen Persicae 9g, decocted in water, daily 1 dose, suitable for endometriosis dysmenorrhea and infertility.
3. Huayu Tongfu Pill: processed with rhubarb vinegar, processed with turtle shell vinegar, amber, 2.5g each time, twice a day, taken with boiled water before meals, without stopping taking medicine during menstruation, and taking it continuously for 3 months is a course of treatment 1. Applicable to empirical cases of endometriosis.
Chinese patent medicine:
1. Woman Tongjing Pill: It has the effects of regulating qi and promoting blood circulation, removing blood stasis and relieving pain. Indications for dysmenorrhea, suitable for dysmenorrhea of qi stagnation and blood stasis type. Take 30 capsules each time, twice a day, orally.
2. Shaofu Zhuyu Pill: It has the effects of promoting blood circulation, removing blood stasis, warming channels and relieving pain. Indications for dysmenorrhea, suitable for dysmenorrhea of cold coagulation and blood stasis type. Each time 1 capsule, twice a day, orally.
3. Tiaojing Mu Yi Tablet: It has the effect of clearing away heat and removing blood stasis. Indications for dysmenorrhea, suitable for dysmenorrhea with blood stasis and heat. 20 ~ 30 tablets or 5 ~ 8 tablets each time, 2 ~ 3 times a day, taken orally.
Acupuncture therapy massage therapy:
1, body acupuncture: take Guanyuan, Zhongji, Hegu and Sanyinjiao points, once a day 1 time, 7 times in a row, and keep needles for 20 minutes each time, and treat them before or during menstruation.
2, auricular point pressing seeds: Take the uterus, endocrine, liver meridian and other points, apply magnetic powder or vaccaria seed to the points, press and stimulate several times a day to treat dysmenorrhea.
3. Massage up and down along the ren meridian, starting from Shenque, massage Qihai, Guanyuan, Shu Tian, Siman, Huilai, Uterus and Qichong in turn, and massage each acupoint for 1 min, starting from 7 days before menstruation and ending 3 days after menstruation, which is suitable for dysmenorrhea patients.
Other therapies:
dietotherapy
1. Chinese rose soup: Chinese rose 15g, appropriate amount of brown sugar, decoction. Suitable for infertility caused by qi stagnation and blood stasis.
2. Hawthorn charcoal 30g, brown sugar 30g, sunflower seed 15g, decocted in 2 small bowls twice a day. It is suitable for dysmenorrhea of blood stasis type.
(2) applied therapy
1. Shexiang Powder plus Gui Xiang Huoxue Ointment or Dinggui Powder plus Gui Xiang Huoxue Ointment is externally applied to the lower abdomen. It is suitable for patients with endometriosis mass near abdominal wall.
2. Fu Gui Zijin Ointment: every time 1 paste, stick it on the lower abdomen, and warm it to melt. Used for dysmenorrhea and abdominal pain caused by wind-cold.
(3) enema therapy: salvia miltiorrhiza 30g, Rhizoma Sparganii 20g, Rhizoma Curcumae 20g, Radix Angelicae Sinensis 20g, Caulis Sargentodoxae 30g, Herba Patriniae 20g, Semen Persicae 20g, Flos Carthami 20g, Rhizoma Chuanxiong 15g, Rhizoma Corydalis 15g, and Radix et Rhizoma Rhei 100 ml, and enema100 is reserved every night. It is suitable for endometriosis dysmenorrhea, ovarian endometriosis cyst and rectal endometriosis.
(4) Vaginal administration method: the stalactites, frankincense, myrrh, Sanguis Draxonis, Rhizoma Sparganii and Rhizoma Curcumae are equally divided, filtered and screened, and disinfected for later use. Take 5- 10g powder each time, put it in the posterior fornix of vagina, then wrap it with a cotton ball with tail, and take it out after 24 hours, every three days 1 time, starting from the time when menstruation is clean. It is suitable for patients with endometriosis, posterior fornix nodules or concave masses of uterus and rectum.
Principles of treatment:
Endometriosis is a difficult disease in clinic. Whether it is simply treated with Chinese medicine or western medicine, the long-term effect is not very ideal. In recent years, people pay more and more attention to the combination of traditional Chinese and western medicine. We should combine them organically and apply them in clinic, give full play to their respective advantages and learn from each other's strengths to improve clinical efficacy.
First, reduce the dosage of hormone drugs, combined with Chinese medicine treatment.
Because endometriosis is a hormone-dependent disease, western medicine mainly uses hormones to treat it, but the course of treatment is long, often taking it for more than half a year, and the side effects are great, such as impotence, amenorrhea, menopausal syndrome and so on. Although endometriosis has been relieved in different degrees during the treatment, it has brought new pain to patients, and the recurrence rate is high after drug withdrawal. For example, in the combination of traditional Chinese and western medicine, hormone therapy can be used for 1 ~ 2 months, and then it can be stopped and replaced by traditional Chinese medicine. According to the clinical symptoms, signs and tongue pulse, the treatment is mainly to promote blood circulation and remove blood stasis, and the menstrual cycle can be regulated by soothing the liver and regulating qi, warming meridians and dispelling cold, invigorating qi and rising yang, clearing heat and tonifying kidney.
Especially in menstrual period, promoting blood circulation and removing blood stasis can make the old blood stasis focus go with menstrual blood, and at the same time prevent the generation of new blood stasis focus. It can eliminate dysmenorrhea, regulate menstruation and help pregnancy, that is, reduce the dosage of hormone drugs, balance yin and yang, regulate qi and blood, eliminate diseases and restore health. Moreover, traditional Chinese medicine has no obvious side effects and can be pregnant during treatment, which is easy for patients to accept.
2. TCM prevention and treatment after induced abortion.
According to clinical reports, the rising incidence of endometriosis is closely related to induced abortion and intrauterine devices. In order to reduce the incidence of endometriosis, Chinese medicine can be used for preventive treatment of patients after induced abortion. Oral Chinese medicine can promote the discharge of blood stasis in uterine cavity, thus reducing the stress response of surgery, adjusting the balance of neuroendocrine-immune function, dredging the blood flowing back from pelvic cavity and preventing the blood flowing back from uterine cavity, and reducing the incidence of endometriosis. From the perspective of prevention, Chinese medicine treatment can play a decisive role.
Third, tonifying kidney and promoting blood circulation may become the direction of future treatment.
Traditional Chinese medicine believes that endometriosis is mainly caused by blood stasis, so it is always necessary to promote blood circulation and remove blood stasis in treatment. In recent years, some people think that blood stasis is caused by kidney deficiency, especially infertility caused by mild endometriosis. More than 80% of the infertility is caused by excessive lactation, follicular development disorder, corpus luteum deficiency and luteinization of unruptured follicles. By nourishing kidney and marrow, soothing the liver, promoting blood circulation and removing blood stasis, the pregnancy rate of this disease can be further improved. Therefore, TCM syndrome differentiation of kidney deficiency, liver stagnation and blood stasis is more scientific. Others believe that kidney-warming drugs do have similar endocrine hormone effects, which can regulate gonad and adrenal function and stimulate adrenal gland to release corticosteroids. In addition, kidney-tonifying drugs have certain estrogen and progesterone-like effects, so tonifying kidney and promoting blood circulation may become the direction of treating endometriosis in the future. People will look forward to a new method and drug to treat this disease, which has no side effects and can cure the disease.
Treatment should be based on the etiology, the essence of blood stasis, mainly to promote blood circulation and remove blood stasis, and then according to the deficiency and excess of cold and heat, methods such as soothing the liver and regulating qi, warming meridians and dispelling cold, benefiting qi and tonifying kidney, clearing heat and eliminating symptoms should be applied respectively. Combined with different periods of menstrual cycle and different constitutions, we should treat them separately, guide them according to the situation, and strengthen the body resistance and eliminate evil. It can also be combined with acupuncture, external application of traditional Chinese medicine, enema and other methods to improve clinical efficacy. The treatment of this disease should be based on the principles of "tonifying deficiency", "excess diarrhea", "treating deficiency by excess" and "emphasizing deficiency", focusing on promoting blood circulation and removing blood stasis, and treating according to different causes and diseases. Such as treating qi stagnation, regulating qi and soothing the liver; Cold coagulation is treated by warming meridians and dispelling cold; Qi deficiency is treated by supplementing qi and rising yang; Those who are depressed by heat, clearing away heat; Kidney deficiency is treated by tonifying kidney and regulating menstruation. According to the new condition and physical strength, it is necessary to decide whether to eliminate evil mainly or strengthen the body resistance to eliminate evil, or to strengthen the body resistance first and then eliminate evil, so we should master it flexibly in clinic. At the same time, different treatment methods can be adopted in combination with the changes of blood loss in different periods of menstruation. Generally speaking, regulating qi and removing blood stasis are the main methods before menstruation; Menstruation, mainly promoting blood circulation and removing blood stasis, regulating temperature and relieving pain; After menstruation, it is mainly to replenish qi and kidney, promote blood circulation and remove blood stasis. That is to say, before menstruation, eliminate evil spirits first, and after menstruation, strengthen the body and eliminate evil spirits. Oral decoction is effective in clinic. In order to improve the clinical curative effect, acupuncture, enema and external application of ointment can be used at the same time, which can shorten the course of treatment and accelerate the recovery of the disease.
Efficacy and prognosis:
Criteria for judging curative effect of endometriosis;
1. cure
(1) Conservative treatment: ① dysmenorrhea disappeared; ② Normal menstruation; ③ Normal uterine size, adhesion absorption, nodules and thickening disappeared.
(2) Surgical treatment: ① The main focus has been removed, and the remaining adhesion or thickened tissue has basically disappeared; ② The clinical symptoms disappeared; ③ Abdominal or other wounds healed well; ④ Good recovery after operation.
improve
(1) The clinical symptoms basically disappeared.
(2) The abdominal mass shrinks.
3. Ineffective: Symptoms have not changed or worsened after treatment.
Prevention:
The prevention of this disease should focus on: ① prevention of menstrual blood backflow: if congenital genital malformation hinders menstrual blood outflow, it should be treated by surgery in time, and pelvic examination is generally not done during menstruation. Be gentle when necessary to avoid squeezing the child. ② Avoid endometrial implantation caused by operation: For example, when fetuses are taken by cesarean section, gauze pad should be used to protect the operation field to prevent the contents of uterine cavity from overflowing into abdominal cavity or abdominal incision. Before operation, tubal patency test, cervical freezing, electrocautery, conization and plastic surgery are prohibited. When people suck the uterus, the negative pressure in the uterine cavity should not suddenly decrease, and it is not appropriate to squeeze the uterus by hand after sucking the uterus. ③ Age-appropriate marriage and childbearing and drug contraception: Inhibition of pregnancy and ovulation can reduce or delay the occurrence of this disease.
The above is for your reference.
I wish you a happy and healthy holiday.