阿司匹林对重度宫腔粘连电切术后子宫内膜的影响

Effects of aspirin on the endometrium of patients with severe intrauterine adhesions after electrical resection

目的探讨阿司匹林对重度宫腔粘连电切术后子宫内膜的影响。方法选取2013年8月～2015年8月丽水市妇幼保健院妇科收治的130例接受宫腔粘连电切术的重度宫腔粘连患者,将其按照随机数字随机分为观察组和对照组2组,每组65例,对照组给予雌孕激素序贯疗法进行治疗,观察组在对照组基础上给予阿司匹林进行治疗,2组均治疗3个月经周期,在B超下观察比较2组治疗前后排卵日的子宫内膜厚度、子宫动脉血流指标动脉搏动指数（PI）、阻力指数（RI）及子宫内膜的血流参数[血管化指数（VI）、血流指数（FI）、血管化血流指数（VFI）],并记录2组月经恢复情况,治疗3个月经周期后再次行宫腔镜检查宫腔形状进行疗效评定,同时2组均随访1年,统计2组1年内妊娠率。结果治疗后观察组总有效率为92.3%显著性高于对照组的69.2%（P〈0.05）。治疗后2组子宫内膜厚度及PI、RI、VI、FI、VFI均较治疗前显著改善（P〈0.05）,观察组改善更为明显（P〈0.05）。观察组1年内妊娠率为57.1%显著高于对照组的26.5%（P〈0.05）。结论在雌孕激素序贯疗法基础上应用阿司匹林可显著改善改善子宫内膜厚度,增加子宫内膜血流,提高妊娠率,其机制可能与促进子宫内膜修复,改善子宫血流灌注量有关。

Objective To investigate the effect of aspirin on the endometrium of patients with severe intrauterine adhesions after electrical resection.Methods 130 patients with severe intrauterine adhesions after electrical resection from August 2013 to August 2015 in our hospital were selected and randomly divided into the observation group and the control group（65 cases in each group）;The control group were given progestogen sequential therapy,while the observation group were given aspirin for treatment on basis of the control group;All the two groups were treated for three menstrual cycles;Before and after treatment indexes including uterine endometrial thickness,ovulation of the uterine artery blood flow index artery pulsatility index in ultrasound（PI）,resistance index（RI）,endometrial blood flow parameters[vascular index（VI）,flow index（FI） and vascular blood flow index（VFI） ] were recorded and compared,as well as menstruation and uterine cavity shape 3 menstrual cycles after treatment;All the two groups were followed up for one year,and one year pregnancy rates in the two groups were recorded.Results After treatment,the total efficiency in the observation group was 92.3% significantly higher than 69.2% in the control group（P〈0.05）.After treatment,in the two groups endometrial thickness,PI,RI,VI,FI and VFI were significantly improved compared with before treatment（P〈0.05）,but the observation group improved more obviously（P〈0.05）.Within one years in the observation group the pregnancy rate was 57.1% higher than that in the control group 26.5%（P〈0.05）.Conlcusions Application of aspirin can significantly improve the endometrial thickness on the basis of estrogen and progesterone sequential therapy,increase the endometrial blood flow and improve the pregnancy rate,which mechanism may be related to promoting endometrial repair and improving blood perfusion of the uterus.