不同干预方案对行TCRA术重度宫腔粘连患者宫腔再粘连率、TGF-β1及妊娠结局的影响

Effects of different intervention protocols on readhesion rate,TGF-β1,and pregnancy outcome of patients with severe intrauterine adhesion undergoing TCRA

目的探讨球囊单用与球囊＋氧化再生纤维素膜（ORC）方案对行宫腔镜下宫腔粘连分离术（TCRA）重度宫腔粘连患者的宫腔再粘连率、转化生长因子-β1（TGF-β1）及妊娠结局的影响。方法选取2014年5月-2016年5月在该院行宫腔镜下宫腔粘连分离术（TCRA）治疗的重度宫腔粘连患者共100例,采用随机数字表法分为对照组（50例）和观察组（50例）,分别行球囊单用和球囊＋ORC方案进行干预;比较两组患者临床疗效、宫腔引流量、子宫内膜厚度、宫腔容积、血流指数、治疗前后月经量、TGF-β1水平、随访再粘连率、术后首次妊娠时间、自然流产率及妊娠率。结果观察组患者治疗总有效率显著高于对照组（P〈0.05）;观察组患者宫腔引流量、子宫内膜厚度、宫腔容积及血流指数均显著优于对照组（均P〈0.05）;观察组患者治疗后1、6及12个月月经量显著多于对照组（P〈0.05）;两组患者治疗后TGF-β1水平均显著高于治疗前（均P〈0.05）;但观察组患者治疗后TGF-β1水平显著低于对照组（P〈0.05）;观察组患者随访再粘连率显著低于对照组（P〈0.05）;同时观察组患者术后首次妊娠时间、自然流产率及妊娠率均显著优于对照组（均P〈0.05）。结论球囊＋ORC方案用于行TCRA术治疗的重度宫腔粘连患者可有效增加子宫内膜厚度和容积,促进月经恢复,降低TGF-β1水平,避免粘连再发,并有助于改善妊娠结局,价值优于球囊单用。

Objective To explore the effects of separate application of balloon and balloon combined with oxidized regenerated cellulose membrane（ ORC） on readhesion rate,transforming growth factor-β1（ TGF-β1）,and pregnancy outcome of patients with severe intrauterine adhesion undergoing transcervical resection of adhesion（ TCRA）. Methods From May 2014 to May 2016,100 patients with severe intrauterine adhesion undergoing TCRA in 181 st Hospital of Chinese People＇s Liberation Army were selected and divided into control group and observation group,50 patients in each group. The patients in the two groups were treated with separate application of balloon and balloon combined with ORC,respectively. The clinical effects,the volumes of uterine cavity drainage,endometrial thicknesses,uterine cavity volumes,blood flow indexes,menstrual volumes and TGF-β1 levels before and after treatment,readhesion rates during follow-up,the first pregnancy time after operation,spontaneous abortion rates,and pregnancy rates in the two groups were compared. Results The total effective rate in observation group was statistically significantly higher than that in control group（ P〈0. 05）. The volume of uterine cavity drainage,endometrial thickness,uterine cavity volume,and blood flow index in observation group were statistically significantly better than those in control group（ P〈0. 05）. Menstrual volume at 1,6,and 12 months after treatment in observation group were statistically significantly higher than those in control group（ P〈0. 05）. In the two groups,the levels of TGF-β1 after treatment were statistically significantly higher than those before treatment（ P〈0. 05）. The level of TGF-β1 after treatment in observation group was statistically significantly lower than that in control group（ P〈0. 05）. The readhesion rate during follow-up in observation group was statistically significantly lower than that in control group（ P〈0. 05）. The first pregnancy time after operation,spontaneous abortion rate,and pregnancy rate in observation group were statistically significantly better than those in control group（ P〈0. 05）. Conclusion Separate application of balloon and balloon combined with ORC can effectively increase endometrial thickness and volume,promote menstrual recovery,reduce the level of TGF-β1,and avoid recurrence of adhesion in treatment of patients with severe intrauterine adhesion.