宫腔粘连术后放置宫内节育器疗效分析

Clinical effect of intrauterine device after transcervical resection of adhesion

目的探讨宫内节育器在宫腔粘连(IUA)术后预防粘连复发的意义。方法收集2013年7月至2013年12月因IUA就诊于西安交通大学第二附属医院58例患者作为研究对象,年龄在21~35岁,择期行IUA松解术,术后给予早期宫腔镜检查及口服大量雌激素预防粘连复发,并将其随机分为两组,其中38例术后立即放置宫内节育器者为实验组,另20例术后未放置节育器者为对照组。另选取本院因不孕行宫腔镜检查且未见明显异常、年龄在22~37岁之间的30例患者定义为非粘连患者。粘连患者术后3个月行宫腔镜检查判断粘连复发情况,并分别检测粘连患者术前、术后3个月及非粘连患者子宫内膜腺上皮细胞核中雌激素受体(ER)、孕激素受体(PR)表达水平。结果实验组IUA复发率为7.9%,对照组IUA复发率为35.0%,组间差异有统计学意义。粘连患者(包括实验组及对照组)术后3个月子宫内膜腺上皮细胞核中ER表达水平较术前有所降低,但仍高于非粘连患者,其中以实验组降低幅度更明显(P<0.05);但子宫内膜腺上皮细胞核中PR表达各组之间差异无统计学意义。结论IUA术后放置宫内节育器能降低IUA松解术后复发率,作用机理除机械屏障作用外,可能与其降低子宫内膜腺上皮细胞核内ER表达水平有关。

Objective To investigate clinical effect of intrauterine device(IUD)after transcervical resection of adhesion(TCRA).MethodsTotally 58 TCRA patients aged 21-35 years were enrolled in the Second Affiliated Hospital of Xi′an Jiao tong University from July 2013 to December 2013.Lysis of adhesions was given to these patients.Then the patients were divided into experimental group(with IUD group,38 cases)and control group(without IUD group,20 cases).Another 30 infertile patients aged 22-37 years with no obvious abnormalities under hysteroscopy were selected as non-TCRA patients.Adhesive patients received hysteroscopy after three months after the surgery to check for recurrence of adhesion.The expressions of estrogen receptors(ER)and progesterone receptors(PR)in the nucleus of endometrial glandular epithelial cells before and after surgery in TCRA patients as well as in non-TCRA patients were detected respectively.ResultsThe adhesion recurrence rate of the experimental group was 7.9%,and 35.0%in the control group.The recurrence rates significantly differed between the two groups.The expression of ER in the nucleus of endometrial glandular epithelial cells of TCRA patients decreased after surgery,particularly in experiment group.While the ER expression after surgery in both experiment and control groups still higher than that of non-adhesive patients.There was no difference in the expression of PR across groups.ConclusionIUD after TCRA can reduce the recurrence rate of adhesion.And the mechanisms might include mechanical barrier and decreasing level of ER expression in endometrial glandular epithelial cells.