Method for predicting residual adhesion after OCT (Optical Coherence Tomography) navigation uterine cavity adhesion and dissection operation

Abstract

The invention relates to an OCT (Optical Coherence Tomography) navigation uterine cavity adhesion and dissection postoperative residual adhesion prediction method, which comprises the following steps of: acquiring an interference signal of an intraoperative uterine cavity wall area by utilizing OCT equipment, and identifying an adhesion fiber microstructure which is not completely broken so as to judge the existence of an optically invisible residual adhesion microbridge; applying low-frequency bioelectrical stimulation to the wounded area of the uterine cavity during the operation, and marking the wounded area as a tissue repair electrical activity silent area if no blood flow micro-reaction is continuously detected; oCT micro-deformation sequence analysis is carried out on the region after intraoperative dissection is completed, mutation breakpoints of tissue elastic distribution are identified, and the potential risk that traction after-tack occurs in the region is predicted; detecting whether a metabolic oxidation reaction residual zone exists in the operation area or not so as to judge local tissue repair activity decline and re-adhesion tendency; local micro-intervention stimulation is applied to the tissue area judged to be high in risk, OCT imaging is carried out again to detect the reversibility of tissue optical response, and if an image is still fractured and red shift is enhanced, it is judged that the area is the postoperative irreversible adhesion residual area.

Description

Technical Field

[0001] This invention relates to the prediction of residual adhesions after intrauterine adhesion removal surgery, specifically to a method for predicting residual adhesions after OCT-guided intrauterine adhesion removal surgery. Background Technology

[0002] Currently, methods, equipment, and systems for the direct application of non-invasive OCT to the endometrium, such as Chinese patent CN113273968A, offer a non-invasive, zoned, and multi-image acquisition approach for OCT technology in the application of uterine cavity structures. However, in practical applications for predicting residual adhesions after intrauterine adhesion removal surgery, several technical shortcomings and clinical applicability limitations remain. Firstly, this method emphasizes static structural zoning and image analysis by inserting the OCT probe into the uterine cavity to the fundus and then withdrawing it to acquire images of different regions. Its main focus is on the basic morphological configuration of tissues and their echogenicity in a static state, lacking real-time tracking of intraoperative tissue dynamics and monitoring of mechanical behavior. Therefore, it cannot accurately identify optically invisible residual adhesion microstructures during surgery, especially in the early stages when fibrous connections have not yet broken but mechanical loosening has occurred. This technology cannot retrieve microscopic phase perturbation signals from conventional OCT images.

[0003] Secondly, this patent lacks any solutions for the quantitative analysis of high-risk postoperative re-adhesion characteristics such as intervention stimulus response, microcirculation status assessment, and tissue elastic field change tracking, resulting in a lack of multi-dimensional physiological support for predicting postoperative re-adhesion risk. Furthermore, the patented method uses a traditional retraction-type linear scanning path for image acquisition. Although it covers multiple structural areas such as the fundus, upper and lower uterine segments, and cervix, it fails to capture indicators reflecting tissue fatigue and adhesion risk, such as elastic rebound rate and energy consumption ratio, after tissue micro-deformation, due to the absence of OCT phase information for dynamic micro-deformation sequence analysis. This leads to insufficient predictive ability for the postoperative retraction trend of adhesion areas. Simultaneously, its image analysis method lacks the ability to identify changes in redshift in the scattering band and fails to infer pathological indicators such as oxidative reactions and decreased metabolic repair capacity in the surgical area. Therefore, its sensitivity is low when facing areas with latent re-adhesion tendencies where optical density has not completely changed but tissue activity has already decreased.

[0004] Furthermore, this method completely neglects the assessment of intrauterine electrophysiological parameters, and its detection system lacks the ability to acquire dynamic responses of microcirculation under low-frequency electrical stimulation. Therefore, it cannot identify electroquiescent tissue areas, making it difficult to assess whether the tissue repair electrical activity exhibits signs of activity decline or sluggish response; these are crucial for postoperative assessment of the stability of the tissue repair pathway and the integrity of blood supply. Regarding the image partitioning strategy, although the patent divides the uterine cavity into four functional regions, it fails to consider individualized intraoperative lesion distribution morphology differences, nor does it provide targeted algorithmic support for the directionality of adhesion distribution and adhesion types (punctate, sheet-like, bridge-like, etc.). This results in its inability to handle complex cases where residual adhesions are heterogeneously distributed and microstructures are embedded. Summary of the Invention

[0005] The purpose of this invention is to provide a method for predicting residual adhesions after OCT-guided intrauterine adhesion stripping surgery, thereby addressing some of the drawbacks and shortcomings pointed out in the background art.

[0006] The present invention addresses the aforementioned technical problems by employing the following technical solution: a method for predicting residual adhesions after OCT-guided intrauterine adhesion stripping surgery, comprising: acquiring interference signals in the intraoperative uterine cavity wall region using an OCT device; identifying microstructures of adhesion fibers that have not yet been completely severed by analyzing subpixel-level phase shift information to determine the presence of optically invisible residual adhesion microbridges; applying low-frequency bioelectric stimulation to the intraoperative uterine cavity trauma area, while simultaneously acquiring tissue microcirculation response characteristics through OCT dynamic sampling; if no blood flow micromotion response is continuously detected, it is marked as a tissue repair electrical activity silencing zone.

[0007] OCT micro-deformation sequence analysis was performed on the area after intraoperative dissection to identify abrupt breakpoints in the elastic distribution of tissue, thereby determining the postoperative mechanical stress transfer trend and predicting the potential risk of traction re-adhesion in the area; based on the redshift changes in the OCT scattering spectrum band, the presence of residual metabolic oxidation reaction bands in the surgical area was detected to determine the reduced local tissue repair activity and the tendency of re-adhesion.

[0008] For tissue areas identified as high-risk, local micro-intervention stimulation is applied, including hypertonic fluid injection or hypothermic saline treatment, and OCT imaging is performed again to detect the reversibility of the tissue's optical response. If the image still shows fragmentation and redshift enhancement, the area is determined to be a postoperative irreversible adhesion residue area.

[0009] Furthermore, the identification of the microstructure of the adhesive fibers involves dynamically changing the incident angle of the OCT probe to capture non-axial scattering anomalies within the tissue, which is used to discover latent adhesion ridges extending parallel to the cavity wall. The same area is repeatedly sampled using a probe spin-type micro-scanning method. If the phase perturbation results show a directional locking phenomenon, it is determined that there is fiber stress-anchored residual adhesion.

[0010] Furthermore, if the OCT dynamic sampling finds that local blood flow does not respond to low-frequency electrical stimulation, and the electrical stimulation induces an electrical diffusion ring delay phenomenon in the peripheral area, it is defined as the electrical silence center area; before the low-frequency electrical stimulation, a micro-electrosensitive conductive sheet is implanted on the surface of the uterine cavity wall, and the location of the electrical silence area is predicted in advance by the change of the charge accumulation response curve at the interface between the conductive sheet and the tissue.

[0011] Furthermore, by tracking the ratio of tissue rebound speed to energy consumption during the OCT micro-deformation process, a relationship between low-rebound and high-energy-consuming tissue units is established to identify sensitive areas for traction after structural fatigue. When detecting the OCT redshift phenomenon, tissue temperature control changes are introduced. If the redshift intensifies at low temperatures, it is considered a criterion for the exhaustion of metabolic compensation mechanisms. Time drift trajectory analysis is added to the OCT redshift spectrum. If the redshift peak position in a region continues to shift to the right for more than 8-15 seconds, it is considered a region with disordered metabolic buffering capacity.

[0012] Furthermore, if the OCT imaging shows a regional optical density locked zone: the morphology does not recover regardless of temperature or tension changes, it is defined as an irreversible morphological dormant block; if a certain tissue area simultaneously possesses a non-axial phase-locked structure, an electroquiescent response, and low-resilience high-stress hysteresis, it is determined to be a triple risk source of structure and physiology.

[0013] Furthermore, while performing the OCT micro-deformation sequence analysis, the impedance feedback signal of the surgical instrument tip is acquired. If there is an opposite trend between the deformation response of the target tissue area and the change in instrument feedback impedance, the area is determined to be an area where the intraoperative mechanical feedback and tissue response are inconsistent. When applying local intervention stimulation, an incremental stimulation intensity level is set, and OCT imaging is performed at different time points. If there is a nonlinear response trend between the tissue optical properties and morphological changes of the target area at multiple stimulation thresholds, it is determined to be an area with unstable intervention response.

[0014] The aforementioned intelligent intraoperative identification method for hysteroscopic procedures, combining optical coherence tomography (OCT) micro-deformation sequence analysis with a real-time impedance feedback mechanism, is used to predict intraoperatively unvisible residual adhesion areas and postoperatively high-risk re-adhesion areas. This method constructs a comprehensive coupling function. This function is used to express the offset among the mechanical feedback, deformation response, and optical response of the target tissue during the intervention process; the function is defined as follows:

[0015]

[0016] in:

[0017] At any moment Below, the force, shape, and light response coupled offset intensity function of the target tissue region; The first derivative of tissue deformation over time represents the rate of change of tissue length per unit time; The rate of change of impedance at the tip of a surgical instrument over time reflects changes in the operator's applied force or the tissue's resistance behavior; The sign function determines whether the directions are consistent (+1 or -1). If the directions are opposite, it is a negative term to enhance decoupling detection. No. The rate of change of optical reflectance of the target area over time after the intervention stimulus; No. The intensity of the intervention stimulus applied at each stage (such as hypertonic concentration, temperature difference range); The system regulation constant reflects the tissue's attenuation adaptation to stimuli (units in degrees). same); Total number of intervention intensity gradients; Intervention intensity attenuation factor, used for sensitivity normalization of weighted optical response term;

[0018] When the function value When the risk threshold set by the system is exceeded, it is determined that there is a dual instability in the tissue area, namely, inconsistent intraoperative feedback and nonlinear enhancement of intervention response. The surgeon should be prompted to perform supplementary treatment or conduct key postoperative follow-up observation.

[0019] Furthermore, it is determined whether there is a local echo discontinuity phenomenon in the OCT image within the tissue region. If both exist, the region is identified as a structural tension decoupling region. If the deformation direction is inward collapse and the impedance feedback direction is continuously increasing, and the target region shows local optical density enhancement, it is determined to be a stress-retraction type closed tissue region. If an asymmetric peak of strain rate is detected simultaneously in the region where the impedance and deformation directions are opposite, it is defined as a nonlinear load tissue response region.

[0020] Furthermore, if the target region undergoes a reverse change in the OCT tissue boundary position under two consecutive stimulation intensities, the region is identified as a stress direction memory type tissue region; if the optical density response curve shows a decreasing peak trend during three intensity-increasing interventions, the system determines that the tissue has stress tolerance depletion.

[0021] Furthermore, during the incremental intervention stimulation, if the local light absorption rate of the tissue shows a U-shaped trend, the system determines that the region has a metabolic inhibition and compensation mode; in the recovery stage after intervention stimulation, if the target tissue shows a delayed recovery time and is accompanied by structural axis shift in the image, the region is defined as a potential stress migration region; if the boundary of the high-density area in the tissue density map of several pre-response stages becomes diffusely blurred, the region is marked as a structural fracture region.

[0022] The beneficial effects of this invention are as follows: This invention, based on OCT navigation, provides a method for predicting residual adhesions after intrauterine adhesion removal, breaking through the traditional reliance on postoperative imaging or experience-based judgment. It accurately identifies optically invisible microbridges through sub-pixel-level phase shift analysis, and, combined with electrophysiological stimulation and OCT dynamic microcirculation monitoring, can locate tissue repair silencing zones intraoperatively. Furthermore, it identifies areas of structural tension decoupling or inconsistent force-shape responses through spin angle variation incident and feedback impedance-deformation direction analysis, demonstrating high spatial resolution and tissue behavior recognition capabilities. This method not only has the ability to identify overt adhesions but also provides early detection and intervention value for potential re-adhesion trend areas.

[0023] Meanwhile, this invention introduces OCT dynamic response analysis under multi-level intervention intensities during surgery to identify nonlinear behavioral characteristics of tissues, including high-risk signs such as stress memory response, metabolic buffering capacity disorder, optical density lock-in zones, and structural fragmentation areas, significantly improving the accuracy of identifying irreversible areas of postoperative re-adhesion. The system also integrates OCT image data, operational impedance signals, and a coupling function modeling mechanism between stimulation intensity and optical response, achieving closed-loop analysis of the physiological, structural, and mechanical states of adhesions, providing strong technical support for individualized and precise intraoperative treatment. Attached Figure Description

[0024] Figure 1 This is a simplified flowchart for predicting residual adhesions after OCT-guided intrauterine adhesion removal surgery according to the present invention.

[0025] Figure 2 This is a comprehensive judgment relationship diagram of high risk of OCT multimodal residual adhesion in this invention.

[0026] Figure 3 This is a flowchart of the high-risk area determination process under OCT impedance coupling and multi-stage intervention of the present invention.

[0027] Figure 4 This is a simplified flowchart of OCT high-risk identification and intervention during intrauterine adhesion stripping surgery in Embodiment 1 of the present invention.

[0028] Figure 5 This is a simplified flowchart of the identification of high-risk tissues in the uterine cavity under OCT combined with impedance and graded stimulation, as described in Embodiment 2 of the present invention. Detailed Implementation

[0029] The specific embodiments of the present invention will now be described in detail with reference to the accompanying drawings.

[0030] Combined with appendix Figure 1This invention provides a method for predicting residual adhesions after OCT-guided intrauterine adhesion separation surgery. During the intrauterine adhesion separation procedure, an Optical Coherence Tomography (OCT) device is inserted into the uterine cavity via a transvaginal approach. The OCT imaging probe is used to perform real-time intraoperative scanning of the uterine cavity wall and adhesion areas. The OCT device acquires high-resolution three-dimensional structural images of the uterine cavity wall tissue through the principle of interference optics and collects its interference signals. Based on this, a subpixel phase shift analysis algorithm is used to quantitatively calculate the minute phase changes between pixels in consecutive image frames. This identifies microstructures of adhesion fibers that are difficult to distinguish under conventional structural imaging but exhibit subtle continuity in phase information. This allows for the determination of whether there are incompletely broken adhesion residues in the area, i.e., optically invisible residual adhesion microbridges, serving as a structural basis for potential re-adhesion risk. Subsequently, low-frequency bioelectric stimulation is applied to the identified adhesion or trauma areas during the procedure. The stimulation is delivered via a controllable electrical stimulation module, outputting low-intensity square waves or bipolar waveforms at frequencies from 0.5Hz to 5Hz. These waves are then applied to the surface of the uterine cavity trauma via a conductive probe or electrode pad to activate the electrophysiological activity of the local tissue. Simultaneously, the OCT device continuously performs dynamic sampling to observe the responsiveness of the target area's microcirculation system under electrical stimulation, specifically detecting periodic changes or micro-motions in the capillary layer or superficial tissue. If no significant changes in optical scattering, enhanced blood flow signals, or structural response fluctuations are detected within multiple consecutive stimulation cycles (e.g., more than three cycles), the system marks this tissue area as an "electro-silent zone." Electrophysiological non-responsiveness in this area is considered a manifestation of low tissue repair capacity or impaired regeneration. Combined with the aforementioned phase-recognition information on adhesion microbridges, this can further determine whether the area represents a residual adhesion region with both structural and physiological risks.

[0031] After the adhesion separation operation is completed intraoperatively, OCT micro-deformation sequence analysis is performed on the target area. This involves continuous time-series imaging of the area at a high frame rate, capturing the deformation trajectory changes of the tissue within a unit of time under conditions of slight force loading or natural deformation. By comparing the changes in optical reflection intensity of each pixel and its surrounding area in the time series, the distribution map of tissue elasticity changes is further deduced, and boundary breakpoints of abrupt changes in elastic parameters are identified in the map. These breakpoints are considered to be areas of abrupt changes in mechanical property gradient, representing key locations where stress concentration and changes in transmission direction occur during the postoperative natural recovery process. Based on this, the risk of tissue re-adhesion and traction re-adhesion can be predicted when subjected to physiological traction such as uterine contraction and endometrial hyperplasia during the postoperative period. Furthermore, based on the above OCT micro-deformation analysis, OCT is introduced... Spectral scattering analysis acquires tissue reflection signals at different wavelengths and compares the trajectory of the center wavelength change of the scattering spectrum at different times or under different stress states during surgery. If a stable redshift (i.e., a shift in the direction of wavelength) is observed at the center of the reflection spectrum, combined with the image grayscale enhancement signal to confirm that there is a certain degree of increase in optical density in this area, this redshift feature is inferred to be a residual expression area of ​​metabolic oxidation reaction in the surgical area. Since it is often closely related to extracellular matrix remodeling, free radical accumulation, and decreased repair metabolism, it can be determined that this area has a tendency of reduced local repair activity and becomes the starting core area for re-adhesion formation. Through this technical process, the surgeon can obtain a re-adhesion prediction map based on elastic gradient and spectral metabolic characteristics immediately after the dissection is completed, realizing the visual assessment and early intervention of high-risk areas after surgery.

[0032] After preliminary analysis of OCT image data and identification of high-risk tissue areas with potential re-adhesion risk, local micro-intervention stimulation was further applied to these areas to test the reversibility of their optical response. This micro-intervention included, but was not limited to, local injection of hyperosmolar fluids (such as mannitol or high-concentration glucose solution) or short-term contact with hypothermic saline (temperature controlled between 4°C and 10°C) to induce a mild physicochemical stress response in the target tissue under osmotic pressure or temperature disturbances, thereby altering its intercellular structure, vascular tension, or collagen fiber arrangement. Immediately afterwards, a second OCT image of the intervention area was performed and compared with the initial image. The system primarily observes the changing trends of two types of optical indicators. The first is the integrity of the image structure. If the suspected adhesion area still shows boundary breaks, poor structural continuity, or new optical density gaps in the image after intervention, it indicates that the tissue has lost its strain repair ability of normal tissue structure. The second is the change in spectral scattering. If several prognostic images show a further red shift of the center wavelength or an increase in scattering intensity under the same scanning parameters, it suggests that the area exhibits non-physiological metabolic inertia or enhanced collagen cross-linking response under physiological stimulation. Based on this, the system marks the area as "postoperative irreversible adhesion residue area" and suggests that the surgeon take supplementary intervention, postoperative key monitoring, or local occlusion prevention measures.

[0033] Combined with appendix Figure 2 In the process of identifying adhesions, to improve the detection sensitivity of latent adhesion structures, a multi-angle scanning imaging method is adopted to dynamically change the incident angle of the OCT probe to perform multi-angle scanning imaging of the target uterine cavity wall region. Dynamic changes include controlling the OCT probe to change the beam incident direction within a micro-amplitude range in set angle steps (e.g., within ±5°), and realizing non-axial optical projection through an optical path control system. This enhances the detection capability of adhesion structures that are difficult to identify under traditional vertical incident angles, especially latent adhesion ridges growing or adhering along the parallel direction of the cavity wall in the tissue. Since such adhesion structures appear as low-contrast areas in axial scattering signals, but their fiber arrangement direction causes changes in scattering angle and phase anomalies under non-axial scattering paths, non-axial scattering can be used to detect these adhesions. Abnormal irradiation points were used as indicative features to initially pinpoint the distribution of latent adhesions. Further, the spin-type micro-scanning mechanism of the OCT probe was employed. This involved small-amplitude rotation of the probe's optical axis around its central axis, with high-frequency phase resampling of the same area during rotation. A phase perturbation analysis algorithm was used to extract the directional features of minute phase shifts between multiple frames. If the sampled phase perturbations exhibited a consistent dominant direction, indicating a trend of directional locking, it suggested the existence of stable anchoring points for structural stress within the tissue in that area. This phenomenon is closely related to the consistency of fiber arrangement and the persistence of tension. Therefore, it can be determined that there are fiber stress-anchored residual adhesions in this area. This type of adhesion has a high probability of re-adhesion during the postoperative recovery period.

[0034] For functional identification of tissue repair status, dynamic sampling of the local area after intrauterine adhesion removal is performed using OCT equipment. Microcirculation response signals of the tissue under low-frequency electrical stimulation are collected. Low-frequency electrical stimulation is applied at a frequency of 1Hz to 3Hz to the wound edge or suspected areas of residual adhesion. Simultaneously, changes in blood flow signals in the capillary layer within the target area are monitored in real time. If no corresponding increase in blood flow micromotion, blood flow frequency shift, or scattering dynamic disturbance response is detected in the optical signal within multiple consecutive stimulation cycles, it can be preliminarily determined that the local tissue does not respond to bioelectrical stimulation. If a ring-shaped diffusion delay is observed at the stimulation edge area, i.e., the peripheral tissue gradually produces an electrical response a few seconds after stimulation, while the central area remains silent, the system defines this structural feature as an "electroquied central area." This area typically represents a state of significantly reduced local tissue repair activity, interrupted electrophysiological coupling conduction, or metabolic imbalance. To predict the presence of electrically silent areas before electrical stimulation, a micro-electrosensitive conductive sheet is implanted on the surface of the uterine cavity wall before stimulation. The conductive sheet is a flexible implantable capacitive electrode that can record the dynamics of charge accumulation in real time at the tissue-conductive sheet interface. By applying a small probe current and simultaneously recording the interface potential change curve, a tissue charge response-time integral curve is constructed. When the curve shows a hysteretic response, a deviated charge-discharge curve, or an abnormally slow rate of capacitance change, it can be determined that there is charge isolation or conduction blockage in the tissue area. This serves as a spatial prior information for potential electrically silent areas, thereby enabling early marking and intervention planning of areas with low local functional activity before stimulation is applied.

[0035] By performing OCT micro-deformation sequence imaging on the postoperative adhesion and detachment area, the deformation process of the target tissue under external micro-loading or natural physiological disturbance conditions is recorded. Furthermore, the rebound speed and corresponding energy dissipation of the tissue structure after the release of external force are tracked. The energy dissipation ratio is represented by the difference in the integral area of ​​the optical response under strain loading and unloading paths. The rebound speed is calculated by pixel structure displacement time inversion in consecutive frames. If a tissue unit exhibits a significantly slow rebound speed and a high energy dissipation ratio, it can be identified as a re-tension-sensitive area under a state of structural fatigue accumulation. Such areas are highly susceptible to tissue re-aggregation or adhesion during postoperative recovery due to mechanical tension return. In addition, when detecting redshift in OCT images, tissue temperature control perturbation is introduced, i.e., temperature changes are applied to the imaging area. Intervention (e.g., cooling from room temperature to 8℃~10℃) was performed, and the trend of spectral scattering signal changes under cold stimulation was recorded simultaneously. If the redshift amplitude of the target area increased under low temperature conditions, it indicated that the tissue metabolism was in a passive accommodation state and could not inhibit oxidative stress response through normal energy pathways. Based on this, the system identified the temperature-sensitive redshift response area as a metabolic compensation mechanism exhaustion area. Furthermore, in order to dynamically evaluate the buffering metabolic capacity of this type of tissue, a time drift trajectory analysis module was introduced on the basis of OCT redshift spectrum to continuously track the redshift peak position of each region and calculate its shift trend and duration. If the redshift peak of a certain region continued to shift to the right for more than 8 to 15 seconds, it indicated that the tissue lacked the ability to quickly restore metabolic homeostasis, and the system marked it as a "metabolic buffering capacity disorder area".

[0036] Multimodal OCT image analysis was used to comprehensively identify postoperative intrauterine tissue regions. Specifically, when regional optical density-locked bands appeared in the OCT images—meaning that the OCT image structure remained unchanged after applying different temperature perturbations (e.g., from room temperature to 8°C) or mild tension interventions (e.g., intrauterine traction, local vibration) to the target area—disappearing with blurred boundaries, uniform light scattering, and static phase response—these regions were defined as "irreversible morphological dormant blocks." This indicates that the tissue morphology has lost its biomechanical elasticity and metabolic dynamic activity, typically representing terminal pathological changes such as excessive collagen cross-linking or tissue calcification, which are difficult to reverse through intervention. Furthermore, multidimensional information overlay analysis was performed on the aforementioned regions. If the tissue area simultaneously possesses three key pathological features: first, a non-axial phase-locked structure, meaning that the phase perturbation obtained by sampling the rotation angle of the OCT probe is always concentrated in a single direction, indicating the existence of stable directional stress anchoring; second, an electroquiescent response, meaning that no blood flow micromotion or charge response is continuously displayed under low-frequency electrical stimulation, indicating that the tissue is in a state of interrupted functional electrical activity; and third, low rebound and high stress hysteresis, meaning that the tissue recovery speed is significantly reduced and accompanied by large strain energy consumption during OCT microdeformation. Based on the above three indicators, the system determines that this area is a "triple risk source of structure and physiology," with a high probability of adhesion recurrence and a tendency for ineffective intervention, and should be included in the priority treatment area during surgery and the key area for postoperative follow-up.

[0037] Combined with appendix Figure 3 While performing OCT micro-deformation sequence analysis, the impedance feedback signal of the surgical instrument tip is acquired. The system records the micro-deformation response of the target tissue under intraoperative stress in real time and simultaneously extracts the impedance change trend of the surgical instrument. If the deformation rate of a certain tissue area is observed to be opposite to the impedance change trend of the instrument, that is, when the tissue shows continuous indentation or delayed recovery, but the instrument impedance continues to rise, it indicates that there is abnormal mechanical conduction or reverse deformation behavior of the tissue in this area. The system marks this area as a "region where intraoperative mechanical feedback and tissue response are inconsistent". Further, local intervention stimulation with increasing intensity (such as graded hypertonic solution injection, low-temperature saline coverage, etc.) is applied to this area, and OCT imaging is performed at multiple stimulation time points. If the optical reflectance or structural morphology of the target area shows nonlinear or fluctuating response under different stimulation thresholds, such as a sudden increase in local reflectance or increased structural ambiguity, it is marked as a "region with unstable intervention response", indicating that there is a potential structural and metabolic instability in the tissue. In order to uniformly quantify this process, a coupling function is constructed. This function is used to comprehensively assess the intensity of three types of signal offsets during the intervention process. The function is defined as follows:

[0038]

[0039] in:

[0040] : Indicates the time. The force-shape-light response coupling offset intensity of the target tissue region;

[0041] : Tissue length change rate, indicating the instantaneous rebound or collapse tendency of the tissue;

[0042] The rate of change of impedance at the tip of a surgical instrument reflects changes in external force or tissue resistance.

[0043] : Sign function, when the deformation and impedance directions are consistent. The opposite direction is This is used to emphasize the phenomenon of mechanical decoupling;

[0044] : No. The instantaneous rate of change of optical reflectivity under a single stimulus;

[0045] : No. The intensity of the intervention stimulus applied each time (the unit can be mOsm / L or ℃).

[0046] The system regulation constant reflects the tissue's adaptation threshold to different stimulus intensities;

[0047] Total number of intervention stimuli or the number of intensity levels;

[0048] : A stimulus intensity attenuation factor used to weight the sensitivity of the optical response corresponding to each intervention.

[0049] Through the real-time calculation of the above coupling function, when If the system safety threshold is exceeded (which can be obtained through preoperative experimental calibration), it indicates that the tissue area has dual unstable characteristics of incoordination of intraoperative mechanical feedback and nonlinear enhancement of optical response. The surgeon should be immediately advised to perform supplementary intervention on the area or include it in the high-risk follow-up list after surgery.

[0050] Based on OCT image acquisition, the system incorporates multi-dimensional physical behavior criteria for auxiliary judgment. First, it performs local structural integrity analysis on the OCT images of the target tissue area during surgery. If spatial discontinuities, breaks, or disordered echo signals appear in the images, it is considered a decoupling phenomenon of structural tension discontinuity, marked as a "structural tension decoupling zone." Such areas typically indicate incomplete stress chain transmission after adhesion dissection, leading to a risk of postoperative anisotropic traction and re-adhesion. Second, the system further identifies the area by combining the direction of micro-deformation response. If deformation analysis reveals that the area mainly exhibits an inward concavity and collapse deformation trend, and the end impedance feedback of the surgical instrument continuously increases during the same time period, it means that despite increased instrument force, the tissue... Instead of exhibiting a corresponding outward expansion trend, the tissue showed inward contraction behavior. This phenomenon, combined with the accompanying increase in optical density in the image, led the system to determine that the area was a "stress-retraction type closed tissue area," indicating a risk of tissue embedding and regenerative closure after surgery. Furthermore, strain rate curves were extracted within the aforementioned area. If significant asymmetry was found in the strain peaks in different directions during deformation, or even multiple jumps or hysteresis characteristics, the area was determined to be a "nonlinear load tissue response area." This reflects that the tissue exhibits a non-homogeneous and unstable response mechanism when subjected to intraoperative manipulation or postoperative mechanical changes, and has a high potential risk of re-adhesion or structural deformation.

[0051] For high-risk areas of postoperative adhesion, the system dynamically tracks the response behavior of tissue boundaries through graded intervention stimulation combined with OCT imaging. In the first stage, the system applies two consecutive levels of stimulation with different intensities (such as different osmotic pressure gradients or temperature differences), and performs high-precision OCT imaging analysis of the tissue boundaries after each level of stimulation. If the boundary displacement direction of the same target area changes in opposite directions under the two levels of stimulation, i.e., the first level of stimulation causes the boundary to expand outward while the second level of stimulation causes it to contract, it indicates that the tissue area has directional stress memory characteristics, showing a biased feedback to the historical mechanical state. Based on this, the system defines it as a "stress direction memory type tissue area", suggesting that the tissue retains the mechanical inertia of the original adhesion traction path and is prone to structural retraction or re-adhesion during the postoperative tension reconstruction process. Furthermore, a third level of higher intensity stimulation was applied to such areas, and the optical density response curves collected after three different levels of stimulation were analyzed. If the curve showed a trend of decreasing peak value at each of the three increasing stimulation levels, it indicated that the tissue exhibited weakened sensing ability or depleted regulatory function during the stimulation enhancement process, and could not maintain a normal optical scattering intensity response. The system judged it to be a state of stress tolerance exhaustion. Such areas represent that the tissue structure and metabolic response pathway have tended to be unstable or irreversible, and should be regarded as a high-priority risk point for postoperative monitoring and treatment.

[0052] The system dynamically analyzes the optical absorption characteristics and structural response behavior of tissues under different stimulation levels by applying progressively stronger intervention stimuli and acquiring OCT images in real time. As the intensity of the intervention stimulus gradually increases, the system tracks the trend of light absorption rate changes in local areas of the target tissue. If light absorption initially decreases with increasing stimulation intensity and then increases again under higher stimulation intensity, exhibiting a typical U-shaped curve, it is determined that the tissue area initially exhibits a state of metabolic inhibition. Further stimulation triggers the activation of compensatory metabolic pathways, demonstrating a dual-mode metabolic regulation capability. Therefore, the system identifies it as a "metabolic inhibition and compensation mode area," indicating a certain degree of regulatory flexibility to external intervention, but still posing a risk of metabolic instability. Secondly, during the recovery phase after stimulation removal, the system continuously performs time-series OCT imaging. If the target area... Significantly delayed recovery after stimulus removal, especially prolonged recovery time of morphological structure, and detection of spatial displacement of structural axes relative to the original state, indicate that the tissue region has undergone stress direction transfer or reconstruction after stimulation. The system marks this as a "stress migration potential area." Such areas may lead to changes in re-adhesion paths or the formation of new stress concentration areas due to mechanical redistribution after surgery. Finally, the system analyzes the tissue density maps acquired during the intervention response phase. If the boundary of a local high-density area changes from clear and sharp to diffuse and blurred, and the boundary clarity decreases in a continuous imaging sequence, it indicates that the continuity of the internal structure of the tissue is damaged or the scattering interface is broken. This area is identified by the system as a "structural fracture area," suggesting that there is irreversible damage after minimally invasive operation or internal fracture caused by stress in this tissue, which is highly unstable.

[0053] Example 1:

[0054] Combined with appendix Figure 4In this embodiment, patient A, 32 years old, with a history of cesarean section for her second child, was diagnosed with moderate to severe intrauterine adhesions due to decreased menstrual flow and secondary infertility, and was scheduled to undergo hysteroscopic adhesiolysis. During the procedure, an OCT navigation system was used for detailed assessment of the surgical area. After initial mechanical separation of most of the anterior wall adhesions, the system operator gradually expanded the incident angle range of the OCT probe from 0° to 30°. At an incident angle of 16°, a lateral scattering enhancement patch was found in the image signal near the left uterine horn. No obvious structure was observed under conventional axial viewing. The system invoked a non-axial scattering anomaly identification algorithm, and after comparing multi-angle tomographic images, determined that a occult adhesion ridge extending parallel to the uterine wall existed in this area, with a size of approximately 1.3mm × 4.2mm. Next, the system activated the spin micro-scanning function, performing 12 phase samples per revolution around the scanning center at a 5° step angle. After three consecutive revolutions, interferogram analysis was performed, revealing that the phase perturbation direction of the latent adhesion ridge region exhibited a fixed offset direction (standard deviation <0.8°) in 38 / 42 samples, with a directional locking rate of 90.5%, consistent with the characteristics of fiber stress anchoring residual adhesion. This suggests to the surgeon that although the structure was not completely broken, its mechanical properties could easily lead to postoperative tractional re-adhesion, and precise detachment and subsequent drug barrier coverage should be performed.

[0055] Subsequently, as the adhesion removal process neared completion, a custom-designed micro-electro-sensitive conductive sheet (8mm × 8mm, 120μm thick) was inserted via hysteroscopy and placed on the surface of the repair area at the fundus of the uterus. Low-frequency bioelectric stimulation with an amplitude of 1.2V and a frequency of 30Hz per cycle was applied. Within 10 seconds of stimulation initiation, the system dynamically acquired blood flow maps. The OCT image of the central area at the fundus of the uterus showed an average blood flow velocity of 0.03mm / s, far below the reference threshold of 0.12mm / s. Simultaneously, a diffuse delayed enhancement of blood flow was observed in the surrounding area. The maximum diameter of the circumferential expansion of the electrostimulation-induced effect reached 8.1mm, and it took 17 seconds to stabilize. Based on this, the system defined this central area as the "electroquied central area." Combined with the tissue interface charge response curve recorded by the electro-sensitive conductive sheet during the pre-stimulation phase, it was found that the cumulative charge change ΔQ at the interface before stimulation remained below 5μC, lower than the set physiological response standard (10μC), indicating that the tissue's response to the physiological pathway of electrostimulation was severely impaired. Based on the two signals mentioned above, the system concluded that, on the one hand, vascular recanalization or neural network reconstruction in this area had not yet occurred, and on the other hand, local cell repair activity was in a quiescent state, indicating a high risk of postoperative re-adhesion. It recommended that the surgeon apply local estrogen gel in combination with hyaluronic acid barrier intervention in this area, and suggested that the patient have a follow-up tissue activity test on the 7th day after surgery to assess the risk of adhesion recurrence.

[0056] After identifying and managing the non-axial adhesion ridges and electroquiescence center area during the surgery for patient A, the surgical team further applied the tissue mechanical fatigue assessment and metabolic buffer function discrimination module to finely monitor the potential re-traction sensitive area in the area where the adhesions were removed. The surgeon used the OCT micro-deformation module to perform dynamic loading tests on the repair band at the uterine fundus and anterior wall, applying a microcirculation deformation disturbance with a tension amplitude of 0.5N and a frequency of 0.1Hz. The system recorded the tissue deformation-rebound behavior and found that after three loading cycles, the maximum rebound velocity of the target area was only 0.21mm / s, while the energy consumption integral per unit deformation (estimated from the hysteresis loop area) reached 4.8mJ. Compared with the baseline value of a typical healthy tissue unit (rebound velocity 0.45–0.55mm / s, energy consumption approximately 1.2–2.0mJ), the system judged it to be in a "low rebound-high energy consumption" state, indicating a high risk of postoperative re-attachment due to structural fatigue or reduced elasticity. Based on this, the system classified it as a "re-traction sensitive unit."

[0057] Subsequently, the operator activated the redshift-temperature control synchronous analysis module for this area. At a base temperature of 37℃, the tissue redshift peak was recorded as 795.4 nm. As the local temperature was gradually lowered to 33℃, the redshift peak was again measured at 800.2 nm (Δλ = +4.8 nm). The system determined that the tissue scattering spectrum showed a significant redshift under cold stimulation, indicating a decreased metabolic compensation capacity or impaired cellular oxygen consumption mechanism in this area, a sign of metabolic compensation mechanism failure. Simultaneously, the system further incorporated time-drift trajectory assessment, continuously collecting spectral changes for 20 seconds. It was found that the redshift peak slowly shifted to the right from the initial 795.4 nm, stabilizing at 803.1 nm, with a drift time of 13.6 seconds. The system categorized this area as a "metabolic buffer imbalance zone," indicating inadequate postoperative blood supply homeostasis in this area, failing to effectively clear inflammatory metabolites or repair factors. Postoperative local blood supply enhancement drug intervention and temperature-controlled stimulation recovery training were recommended.

[0058] More importantly, the system identified an abnormal optical density area with an average diameter of 1.6 mm in the OCT cross-sectional image of this region. This area did not change its morphology under tension disturbance and temperature change, and the image signal showed a continuous saturation state. Combined with the system's identification of it as an "optical density locked zone", it was defined as an "irreversible morphological dormant block". Further superimposed analysis parameters revealed that this region not only exhibited low rebound / high energy consumption deformation characteristics, but also showed non-axial phase locking (locking rate 92.3%), no blood flow response under electrical stimulation (ΔV<0.02mm / s), and insufficient charge response (ΔQ≈3μC). It met the criteria for the "structural and physiological triple risk source". Therefore, the system strongly indicated that this tissue block was one of the most dangerous units for postoperative re-adhesion.

[0059] Based on the above operational data and analysis results, the surgical team immediately adopted a combined intervention strategy: injecting 0.5 mL of hyaluronic acid microspheres locally into the high-risk area and rinsing with cold saline. At the same time, OCT follow-up points were set up on the 7th, 14th and 28th day after the operation to monitor the trend of structural recovery and optical response.

[0060] Example 2:

[0061] Combined with appendix Figure 5 In this embodiment, during a uterine adhesion removal surgery, a 38-year-old female patient developed moderate to severe intrauterine adhesions due to multiple intrauterine procedures. Preoperative evaluation determined that adhesiolysis would be performed under OCT navigation, and intraoperative residual adhesion risk prediction would be implemented. During the procedure, after initial mechanical separation, the surgeon performed OCT microdeformation analysis on two key areas of the inner wall of the uterine cavity, initially identifying the first area... The deformation rate is This indicates that the tissue shows a clear tendency to collapse; simultaneously, the rate of change of the impedance feedback signal is... This indicates that the perceived force from the instrument is increasing, and the two are in opposite directions, suggesting that this area is a "region of inconsistency between mechanical feedback and tissue response." That is, the operator feels increased resistance during surgery, but the actual tissue collapses rapidly, indicating the presence of potential structural fatigue points or unbroken residual microbridges. Subsequently, the doctor applied three levels ( , , Apply local hypertonic fluid stimulation of different intensities and at each time point ( , , OCT image data were acquired, and the rate of change of reflectance over time in three stages was measured as follows: , , Considering the adaptive regulation parameters of the tissue's response to stimuli, Substitute into the coupling function formula:

[0062]

[0063]

[0064]

[0065] because Although there is decoupling between deformation and impedance, the optical response after multi-level stimulation shows a sharp decreasing trend, indicating that the stimulation threshold sensitivity of this tissue area has decreased and has shown a nonlinear desaturation response, suggesting that the tissue is on the verge of stress exhaustion. The system marks it as an "unstable area of ​​intervention response" and recommends that the surgeon further exfoliate this area or closely monitor it after surgery to prevent re-adhesion.

[0066] The surgeon further refined the identification of the high-risk area (located on the posterior wall of the uterus near the isthmus) identified during the operation. First, analysis of continuous OCT image sequences revealed local echo discontinuities in this area during dynamic deformation acquisition. The images showed interrupted boundary continuity and signal instability, and this anomaly persisted in reconstructions from different angles. After ruling out artifacts, it was confirmed as a structural tension decoupling area. At this time, the OCT recorded a local tissue collapse velocity of [missing value]. Meanwhile, the impedance feedback continued to rise to The optical density value is from the original Enhanced to This contrasts sharply with the surrounding area, leading to its further identification as a stress-retraction type closed tissue area. To verify its nonlinear response properties, the surgeon used... , Two levels of continuous electrical stimulation were performed, and the strain rate curves were recorded. It was found that the response peaks on the left and right sides of the tissue area were respectively... and The system exhibits significant offset and peak asymmetry, thus classifying it as a nonlinear load organization response region, indicating that it exhibits an unstable amplification trend in response to external disturbances.

[0067] To further assess whether the patient possessed stress memory attributes, the surgeon then applied two consecutive levels of stimulation to the area, namely, hypertonic saline injection: the first stimulation... The second time was The first inward contraction of the OCT tissue boundary was observed. The second time, however, it expanded outwards. The directions were completely opposite; combining the image sequences revealed a significant difference in temporal memory path reconstruction between the two changes, consistent with the criteria for identifying stress-direction memory-type tissue regions. Further addition of a third stimulus... The peak values ​​of the optical density response were recorded continuously as follows: It shows a clear decreasing trend, and the changes are respectively , This aligns with an exponential decline trend. Based on this, the system determines that the target tissue region exhibits a tolerance exhaustion pattern under stress, meaning that the tissue's regulatory mechanisms are rapidly depleted and unable to maintain a stable recovery response.

[0068] For tissue regions identified as exhibiting nonlinear strain response and stress tolerance depletion, the surgeon further validated and analyzed the metabolic state and structural stability of these regions using an incremental local intervention stimulation experiment. First, the surgeon sequentially applied hypertonic glucose solutions of different concentrations to the target region three times, respectively... , , After each stimulation, local tissue light absorbance data were collected using OCT. The results are as follows: , , The overall trend shows a clear U-shaped change. This phenomenon indicates that the tissue exhibits metabolic inhibition under moderate stimulation (the lowest point appears at...). Under high stimulation, a certain degree of compensatory absorption enhancement occurs, which is consistent with the metabolic inhibition-compensation coexistence mode. The system then marks this region as the nonlinear regulatory region of metabolic response.

[0069] Subsequently, the surgeon observed the dynamic changes in the area during the recovery phase after stimulation was stopped. By recording the rebound path of the tissue boundary contour using continuous OCT imaging, it was found that the recovery delay time in the target area was significantly prolonged to 19.4 seconds (the normal average recovery time is 8.3 seconds, and the delay is more than twice the mean). Simultaneously, the direction of the tissue's main axis changed from the initial... Deflect to The offset angle reached This results in a clear axial torsional trajectory of the structure. Based on this, the system determines that the region has potential stress migration characteristics, meaning that the local mechanical load is redistributed to a non-original path after stimulation, leading to postoperative ectopic retraction.

[0070] Finally, the surgeon guided the OCT into tissue density analysis mode to extract image texture features and perform density mapping on the corresponding areas. In the initial images, well-defined high-density areas (density values ​​greater than [missing information]) were visible. However, within 5 to 15 seconds after the stimulus response, the edges of the high-density region gradually blurred, and the density transition gradient expanded beyond [a certain point]. The original clear boundaries exhibit a similar diffused halo structure, and the increase in texture entropy reaches a significant level. The system defines the structural evolution state as the structural fracture zone, which is characterized by disordered collagen fiber arrangement, unstable interfacial tension, and the propagation of microcracks.

[0071] The foregoing has shown and described the basic principles, main features, and advantages of the present invention. Those skilled in the art should understand that the present invention is not limited to the above embodiments. The embodiments and descriptions in the specification are merely illustrative of the principles of the invention. Various changes and modifications can be made to the invention without departing from its spirit and scope, and all such changes and modifications fall within the scope of the present invention as claimed. The scope of protection of this invention is defined by the appended claims and their equivalents.

Claims

1. A method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection, characterized in that... include: Interference signals in the intraoperative uterine cavity wall region were acquired using OCT equipment. By analyzing subpixel-level phase shift information, microstructures of adhesion fibers that were not completely severed were identified to determine the presence of optically invisible residual adhesion microbridges. Low-frequency bioelectric stimulation was applied to the uterine cavity trauma area during the operation, and tissue microcirculation response characteristics were obtained by combining OCT dynamic sampling. If no blood flow micromotion response was detected continuously, it was marked as a tissue repair electrical activity silencing area. OCT micro-deformation sequence analysis was performed on the area after intraoperative dissection to identify abrupt breakpoints in the elastic distribution of tissue, thereby determining the postoperative mechanical stress transfer trend and predicting the potential risk of traction re-adhesion in the area; based on the redshift changes in the OCT scattering spectrum band, the presence of residual metabolic oxidation reaction bands in the surgical area was detected to determine the reduced local tissue repair activity and the tendency of re-adhesion. For tissue areas identified as high-risk, local micro-intervention stimulation is applied, including hypertonic fluid injection or hypothermic saline treatment, and OCT imaging is performed again to detect the reversibility of the tissue's optical response. If the image still shows fragmentation and redshift enhancement, the area is determined to be a postoperative irreversible adhesion residue area.

2. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 1, characterized in that... The identification of the microstructure of the adhesive fibers involves dynamically changing the incident angle of the OCT probe to capture non-axial scattering anomalies inside the tissue, which is used to discover latent adhesion ridges extending in a direction parallel to the cavity wall. The same area is repeatedly sampled using a probe spin micro-scanning method. If the phase perturbation results show a directional locking phenomenon, it is determined that there is fiber stress anchoring type residual adhesion.

3. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 1, characterized in that... If the OCT dynamic sampling finds that local blood flow does not respond to low-frequency electrical stimulation, and the electrical stimulation induces a ring-shaped delay in the peripheral area, it is defined as the electrical silence center area; before the low-frequency electrical stimulation, a micro-electrosensitive conductive sheet is implanted on the surface of the uterine cavity wall, and the location of the electrical silence area is predicted in advance by the change of the charge accumulation response curve at the interface between the conductive sheet and the tissue.

4. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 1, characterized in that... By tracking the tissue rebound rate and energy consumption ratio during the OCT micro-deformation process, a relationship between low-rebound and high-energy-consuming tissue units is established to identify sensitive areas for traction after structural fatigue. When detecting OCT redshift, tissue temperature control changes are introduced. If the redshift intensifies at low temperatures, it is considered a criterion for the exhaustion of metabolic compensation mechanisms. Time drift trajectory analysis is added to the OCT redshift spectrum. If the redshift peak position in a region continues to shift to the right for more than 8-15 seconds, it is considered a region with disordered metabolic buffering capacity.

5. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 4, characterized in that... If the OCT imaging shows a regional optical density locked zone: the morphology does not recover regardless of temperature or tension changes, it is defined as an irreversible morphological dormant block; if a certain tissue area simultaneously has a non-axial phase-locked structure, an electroquiescent response, and low-resilience high-stress hysteresis, it is determined to be a triple risk source of structure and physiology.

6. The method for predicting residual adhesions after OCT-guided intrauterine adhesion stripping surgery according to claim 1, characterized in that... While performing the OCT micro-deformation sequence analysis, the impedance feedback signal of the surgical instrument tip is acquired. If there is an opposite trend between the deformation response of the target tissue area and the change in instrument feedback impedance, the area is determined to be an area where the intraoperative mechanical feedback and tissue response are inconsistent. When applying local intervention stimulation, an incremental stimulation intensity level is set, and OCT imaging is performed at different time points. If there is a nonlinear response trend between the tissue optical properties and morphological changes of the target area at multiple stimulation thresholds, it is determined to be an area with unstable intervention response.

7. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 6, characterized in that... Determine whether there is a local echo discontinuity in the OCT image within the tissue region. If both exist, the region is identified as a structural tension decoupling region. If the deformation direction is inward collapse and the impedance feedback direction is continuously increasing, and the target region shows local optical density enhancement, it is determined to be a stress-retraction type closed tissue region. If an asymmetric peak of strain rate is detected simultaneously in the region where the impedance and deformation directions are opposite, it is defined as a nonlinear load tissue response region.

8. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 7, characterized in that... If the target region undergoes a reverse change in the OCT tissue boundary position under two consecutive stimulation intensities, the region is identified as a stress direction memory type tissue region; if the optical density response curve shows a decreasing trend in peak value during three intensity-increasing interventions, the system determines that the tissue has stress tolerance depletion.

9. The method for predicting residual adhesions after OCT-guided intrauterine adhesion dissection according to claim 8, characterized in that... If the light absorption rate of a local tissue exhibits a U-shaped trend during the incremental intervention stimulation process, the system determines that the region possesses a metabolic inhibition and compensation mode. During the recovery phase after intervention stimulation, if the target tissue shows a delayed recovery time and is accompanied by structural axis shift in the image, the region is defined as a potential stress migration region. If the boundary of a high-density area in the tissue density map of several pre-response stages becomes diffusely blurred, the region is marked as a structurally broken area.

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