Abstract:

Complex cervical adhesions following cold knife conization in postmenopausal women present a significant clinical challenge for gynecological procedures. The clinical data of two such cases were analyzed. In Case 1, the patient presented with endometrial thickening and abdominal distension, while Case 2 involved a uterine cavity mass with fluid accumulation. Cervical adhesiolysis was performed using ultrasound-guided direct puncture combined with methylene blue staining (Case 1), and blunt dissection with mosquito curved forceps (Case 2), followed by gradual cervical dilation using Hegar dilators and a combined cold knife-electrosurgery technique. Successful adhesiolysis and resection of endometrial lesion were achieved in both cases. The mean operative duration was 40 minutes, with an estimated blood loss of 5 mL. No complications (e.g., uterine perforation or adjacent organ injury) occurred. Ultrasound-guided direct puncture with methylene blue staining or blunt dissection with mosquito curved forceps may overcome surgical limitations in postmenopausal women with post-conization cervical adhesions, offering a safe, minimally invasive, and effective approach for complex cases.

Key words: Uterine cervical diseases, Hysteroscopy, Postmenopause, Ultrasound-guided direct puncture, Blunt dissection, Cervical adhesions