宫腔镜电切术联合雌孕激素序贯治疗中重度宫腔粘连的效果观察

Effect of hysteroscopic resection combined with estrogen-progesterone sequential therapy on moderate-to-severe intrauterine adhesions

目的探讨宫腔镜下宫腔粘连电切术(TCRA)联合雌孕激素序贯治疗中、重度宫腔粘连(IUA)的临床价值。方法抽取2018年1月至2019年1月商丘市中心医院收治的IUA患者108例,按随机数字表法将其分为对照组与研究组,每组54例。对照组行TCRA治疗,研究组行TCRA+雌孕激素序贯治疗。对比两组术后3个月的临床疗效,术前、术后子宫情况[子宫内膜厚度(ET)、宫腔容积、血流指数(FI)]、血清相关指标[转化生长因子-β1(TGF-β1)及基质金属蛋白酶-9(MMP-9)],术后12个月宫腔再粘连率及妊娠率。结果术后3个月,研究组治疗总有效率为94.44%(51/54),高于对照组的79.63%(43/54),P<0.05。术后3个月,两组ET、宫腔容积、FI、MMP-9均较术前均上升而TGF-β1较术前降低(P<0.05),且研究组上述指标与同期对照组比较差异有统计学意义(P<0.05)。术后12个月,研究组宫腔再粘连发生率(11.11%,6/54)低于对照组(27.78%,15/54),妊娠率(40.00%,10/25)高于对照组(14.41%,4/27),P<0.05。结论应用宫腔镜电切术联合雌孕激素序贯治疗中、重度宫腔粘连效果显著,可促进子宫内膜恢复,降低宫腔再粘连发生率,提升术后妊娠率。

Objective To investigate the clinical value of transcervical resection of adhesions(TCRA)combined with estrogen-progesterone sequential therapy in the treatment of moderate-to-severe intrauterine adhesions(IUA).Methods A total of 108 IUA patients admitted to Shangqiu Central Hospital from January 2018 to January 2019 were selected.All patients were divided into control group and study group by random number table method,with 54 cases in each group.Control group was treated by TCRA,and study group was given TCRA and estrogen-progesterone sequential therapy.The clinical efficacy at 3 months after surgery,and uterine conditions,such as endometrial thickness(ET),uterine cavity volume,blood flow index(FI),and serum-related indicators,such as transforming growth factor-β1(TGF-β1),matrix metalloproteinase-9(MMP-9),before and after surgery were compared between the two groups.And intrauterine re-adhesion rate and pregnancy rate at 12 months after surgery were compared between the two groups.Results At 3 months after surgery,the total effective rate of treatment in study group(94.44%,51/54)was significantly higher than that in control group(79.63%,43/54).P<0.05.At 3 months after surgery,the ET,uterine cavity volume,FI and MMP-9 in the two groups increased significantly,while the TGF-β1 significantly decreased compared with those before surgery(P<0.05);and the above indexes in study group were significantly different from those in control group during the same period(P<0.05).At 12 months after surgery,the incidence of intrauterine re-adhesion in study group(11.11%,6/54)were lower than that in control group(27.78%,15/54),while pregnancy rate in study group(40.00%,10/25)were higher than that in control group(14.41%,4/27),P<0.05.Conclusions Hysteroscopic resection combined with estrogen-progesterone sequential therapy has significant effects in the treatment of moderate-to-severe intrauterine adhesions,and it can promote endometrial recovery,reduce incidence of intrauterine re-adhesion and increase postoperative pregnancy rate.