补肾活血方联合宫腔灌注改善宫腔粘连术后子宫内膜容受性的影响

The effect of intrauterine perfusion combined with Bu-Shen-Huo-Xue recipe in the improvement of endometrial receptivity aftersurgery for severe intrauterine adhesion

目的探讨补肾活血方联合宫腔灌注对宫腔粘连术后子宫内膜容受性的影响。方法选取2015年7月至2017年12月我院收治的宫腔粘连患者82例,均行宫腔粘连电切术+宫腔球囊置入术。按照数字表法分为对照组(n=42)和观察组(n=40)。对照组为常规治疗+宫腔灌注治疗,观察组在对照组基础上给予补肾活血方治疗,连续治疗3个月经周期。比较术后3个月两组患者排卵日子宫内膜厚度、子宫动脉血流参数、内膜血流参数及Smad表达水平。结果观察组排卵日子宫内膜厚度及Glycodelin-A水平较对照组高(均P<0. 05);两组子宫内膜类型和容积比较差异无统计学意义(P=0. 18);观察组RI及PI、Smad2、Smad3、PAI-1、ADAM15、ADAM17、TGF-β1、VEGF、CTGF、IGF-1及TNF-α表达水平较对照组低,VI、FI、VFI及u PA水平较对照组高,差异有统计学意义(均P<0. 05)。结论补肾活血方联合宫腔灌注可有效改善宫腔粘连术后子宫内膜容受性。

Objective To investigate the effect of Bu-Shen-Huo-Xue recipe combined with intrauterine perfusion on endometrial receptivity after intrauterine adhesion surgery. Methods Eighty-two patients with severe intrauterine adhesions admitted to our hospital from July 2015 to December 2017 were analyzed.All patients underwent the uterine adhesive electrotomy plus uterine sac implantation.After that,the patients were randomly divided into control group(n = 42) and observation group(n = 40). The control group was given uterine cavity perfusion therapy on the basis of conventional therapy,while the observation group was given Bu-ShenHuo-Xue recipe on the basis of control group therapy for 3 consecutive menstrual cycles.The endometrial thickness,uterine artery blood flow parameters,endometrial blood flow parameters and Smad expression level after 3 months of operation were compared between the two groups.Results Compared with the control group,the observation group had thicker endometrium and higher level of glycodelin-A on the day of ovulation(all P < 0. 05).There was no significant difference in endometrial type and volume between the two groups(P= 0. 18).Compared with the control group,RI and PI and expression levels of Smad2,Smad3,PAI-1,ADAM15,ADAM17,TGF-β1,VEGF,CTGF,IGF-1 and TNF-α were lower while the levels of VI,FI,VFI and uPA were higher in the observation group(all P <0. 05).Conclusion The combination of Bu-Shen-Huo-Xue recipe and intrauterine perfusion can effectively improve the endometrial receptivity after intrauterine adhesion surgery.