中药养膜方改善宫腔镜下宫腔粘连分离术后宫腔粘连的预后

Chinese medicine Yangmo decoction ameliorates intrauterine adhesion prognosis following hysteroscopic adhesiolysis

目的:宫腔镜下宫腔粘连分离术是治疗宫腔粘连的主要方法,术后中度和重度宫腔粘连患者的生育结局仍远不尽如人意。雌孕激素是最常用的宫腔镜下宫腔粘连分离术后辅助治疗方法;然而,雌孕激素不能最大限度地提高妊娠率。本研究旨在评估宫腔粘连分离术后使用中医药方养膜方促进子宫内膜恢复及提高妊娠率的效果。方法:回顾性纳入2021年1月至8月间在中南大学湘雅三医院进行宫腔镜下宫腔粘连分离术且达到纳入标准的427名患者,年龄20~45岁,均被诊断为中度或重度宫腔粘连。将患者分成2组:养膜方组,213名患者,术后给予养膜方(主要成分有人参花、三七花、玳玳花、雪莲花、甘草等)治疗;雌孕激素组,214名患者,术后给予雌孕激素治疗。收集两组患者的基本资料,包括年龄、产次、流产史、月经情况及宫腔操作次数。在进行宫腔镜下宫腔粘连分离术时,由高年资外科医师进行美国生育协会(American Fertility Society,AFS)评分并记录子宫内膜腺体开口的密度。研究术前术后经阴道三维超声的数据,并整合其他参数评估养膜方和雌孕激素的疗效。通过电话随访所有患者来确定妊娠率,随访直至末次宫腔粘连分离术后的6个月。结果:两组术前的基线资料差异均无统计学意义(均P>0.05)。宫腔粘连分离术后养膜方组较雌孕激素组AFS评分降低更显著(P<0.001)、宫腔内子宫内膜腺体开口密度更好(P<0.0001)。养膜方组在末次宫腔粘连分离术后6个月的随访期内具有更好的总妊娠率(40.4%)。结论:养膜方可改善宫腔镜下宫腔粘连分离术后宫腔粘连的预后,其治疗效果优于雌孕激素的综合作用,有助于恢复子宫内膜并提高生育率,可作为有生育需求的宫腔粘连患者的常规辅助疗法。

Objective:Hysteroscopic adhesiolysis(HA)remains the mainstay on treatment for intrauterine adhesions(IUA).The fertility outcome of patients with moderate and severe intrauterine adhesions after HA is still far from satisfactory.Estrogen combined with progesterone is the most common treatment;however,they do not help in improving the fertility rate to the maximum because of the limitations.This retrospective,nonrandomized controlled study will assess the effects of traditional Chinese medicine Yangmo decoction after HA in restoration of the endometrium and improvement of the fertility rate.Methods:A total of 427 patients,who met the inclusion criteria,aged between 20 and 45 years and diagnosed with moderate or severe IUA underwent HA at the Third Xiangya Hospital from January to August 2021,were enrolled for this study.Participants were assigned into 2 groups:A Yangmo decoction group(n=213,patients were given Yangmo decoction consisting of Ginseng flower,Sanchi flower,Daidai flower,Snow lotus,Licorice and so on after HA),and an estrogen and progesterone group(n=214,patients were given estrogen and progesterone after HA).The following basic information was collected retrospectively for both groups,including age,parity,history of abortion,menstrual status,and times of hysteroscopic interventions.American Fertility Society(AFS)score was used by a senior surgeon and the density of opening of endometrial glands was evaluated during HA.The parameters were obtained from three-dimensional transvaginal ultrasound(3DTVUS)preoperatively and postoperatively,to evaluate the efficacy of Yangmo decoction,estrogen,and progesterone.All patients were followed up on telephone to determine the fertility rate until 6 months from the last HA.Results:Based on the basic information collected preoperatively,there were no significant differences between the groups(all P>0.05).Postoperatively,patients in the Yangmo decoction group had a better surgical success rate with a more significant AFS reduction(P<0.001),better density of opening of endometrial glands in the uterine cavity(P<0.0001)after HA,and a better fertility rate(40.4%)in the time of 6 months after the last HA than those of the estrogen and progesterone group.Conclusion:Yangmo decoction has better therapeutic efficacy in the treatment of intrauterine adhesion after HA than the combined effect of estrogen and progesterone.Yangmo decoction helps restore the endometrium and improve the fertility rate,therefore,it can be adopted as a routine practice for IUA patients who have fertility requirements.