宫腔镜下宫腔粘连分离术后不同剂量雌激素治疗对子宫内膜容受性的影响

Effects of different dosage of estrogen therapy on endometrial receptivity of women after hysteroscopic intrauterine adhesion separation

目的:分析宫腔镜下宫腔粘连分离术(TCRA)后应用不同剂量雌激素对子宫内膜容受性的影响。方法:选取2017年1月—2019年6月在本院接受TCRA手术治疗的中、重度宫腔粘连患者232例,按照随机数字原则分为小剂量雌激素组与大剂量雌激素组各116例。比较两组同源框10(Hoxa10)基因的表达及子宫内膜容受性超声评估指标差异。结果:两组宫腔再粘连发生率无差异(P>0.05);治疗后两组子宫内膜Hoxa10基因表达均增加,且大剂量组基因表达高于小剂量组(均P<0.001);大剂量组子宫内膜血流A型比例高于小剂量组(P<0.001),两组子宫内膜厚度、子宫内膜容积及子宫内膜分型构成比无差异(P>0.05);大剂量组子宫螺旋动脉RI及PI值均小于小剂量组(P<0.001),两组子宫螺旋动脉S/D值无差异(P>0.05);大剂量雌激素组子宫内膜血流指数VI、FI、VFI值均大于小剂量组(P<0.05)。结论:宫腔镜术后辅以较大剂量雌激素治疗有利于子宫内膜容受性的改善。

Objective:To analyze the effects of different doses of estrogen on endometrial receptivity after transcervical resection of adhesion(TCRA)by hysteroscopy.Methods:Women who had received TCRA because of medium or heavy intrauterine adhesion were included and were divided into the low-dose estrogen group and the high-dose estrogen group according to the principle of random number from January 2017 to June 2019.The difference of the expression of homologous box 10(Hoxa10)gene and the ultrasonic evaluation index of endometrial receptivity of women were compared between the two groups.Results:There was no significant difference in the recurrence rate of intrauterine adhesion of women between the two groups(P>0.05).After treatment,the expression of Hoxa10 gene in endometrium of women in both groups had increased significantly,and that of women in the high-dose estrogen group was significant higher than that of women in the low-dose estrogen group after treatment(P<0.001).After treatment,the proportion of endometrial blood flow type A of women in the high-dose estrogen group was significant higher than that of women in the low-dose estrogen group(P<0.001).There were no statistically significant differences in endometrial thickness,endometrial volume,and endometrial type composition of women between the two groups(P>0.05).The RI and PI values of the uterine spiral artery of women in the high-dose estrogen group was significant lower than that of women in the low-dose estrogen group after treatment(P<0.001),but there was no statistically significant difference in S/D value of women between the two groups(P>0.05).The values of VI,FI and VFI of women in the high-dose estrogen group were significant higher than that of women in the low-dose estrogen group after treatment(P<0.05).Conclusion:High dose estrogen treatment after hysteroscopy is beneficial to the improvement of endometrial receptivity of women.