宫腔镜下冷刀分离术对宫腔粘连患者宫腔形态恢复及妊娠结局的影响

Effect of hysteroscopic cold knife separation on recovery of uterine cavity morphology and pregnancy outcome in patients with uterine cavity adhesion

目的:探讨宫腔镜下冷刀分离术对宫腔粘连患者宫腔形态恢复及妊娠结局的影响。方法:依据随机数字表法将136例宫腔粘连患者分为对照组(68例)和试验组(68例)。对照组给予宫腔镜下电切术进行治疗,试验组给予宫腔镜下冷刀分离术进行治疗,两组术后均随访1年。比较两组术后3个月的宫腔形态恢复情况,手术指标,术前、术后3个月的子宫内膜厚度、子宫体积、月经量、血清激素水平、血清学指标水平及随访期间的妊娠结局。结果:与对照组术后3个月的总有效率(85.29%)比较,试验组总有效率更高(95.59%,P<0.05)。与对照组比较,试验组手术时间及住院时间更短,术中出血量、膨宫液吸收量更低(均P<0.05)。术后3个月,两组月经量、血清雌二醇(E_(2))、基质金属蛋白酶-9(MMP-9)水平与术前比较均升高,试验组高于对照组(均P<0.05);两组子宫体积与术前比较增大,试验组大于对照组(P<0.05);两组子宫内膜厚度与术前比较均增厚,试验组厚于对照组(P<0.05);两组血清卵泡刺激素(T)、促黄体生成素(LH)、促卵泡刺激素(FSH)、转化生长因子-β_(1)(TGF-β_(1))水平与术前比较均降低,试验组低于对照组(均P<0.05);两组血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)水平与术前比较均升高,试验组低于对照组(均P<0.05)。随访期间,试验组妊娠率为51.47%,与对照组(42.65%)比较,差异无统计学意义(P>0.05)。结论:与宫腔镜下电切术比较,宫腔镜下冷刀分离术可有效调节宫腔粘连患者血清激素及血清学指标水平,改善卵巢功能,减轻机体炎性反应,并可改善患者手术指标、子宫内膜厚度、子宫体积及月经量,进而可促进宫腔形态的恢复,且具有良好的妊娠结局。

Objective:To investigate the effect of hysteroscopic cold knife separation on the recovery of uterine cavity morphology and pregnancy outcome in patients with uterine cavity adhesion.Methods:A total of 136 patients with uterine cavity adhesion were divided into the control group(68 cases)and the test group(68 cases)by the random number table method.The control group was treated with hysteroscopic electrotomy,and the test group was treated with hysteroscopic cold knife separation.Both groups were followed up for 1 year.The recovery of uterine cavity morphology 3 months after surgery,operationl indicators,endometrial thickness,uterine volume,menstrual volume,levels of serum hormone,serological indicators before and 3 months after surgery,and pregnancy outcome during followed up were compared between the two groups.Results:Three months after surgery,compared with the control group,the total effective rate of the test group was higher(85.29%vs.95.59%,P<0.05).Compared with the control group,the operation time and hospital stay of the test group were shorter,and the intraoperative blood loss and dilation fluid absorption were lower(all P<0.05).Three months after surgery,the levels of menstrual volume,serum estradiol(E 2)and matrix metalloproteinase-9(MMP-9)in both groups were increased compared with those before surgery,and the test group was higher than the control group(all P<0.05);the uterine volume in both groups were larger compared with those before surgery,and the test group was larger than the control group(all P<0.05);endometrial thickness increased in both groups compared with that before surgery,and the test group was thicker than the control group(all P<0.05);the serum levels of follicle-stimulating hormone(T),luteinizing hormone(LH),follicle-stimulating hormone(FSH)and transforming growth factor-β1(TGF-β1)in both groups were decreased compared with those before surgery,and the test group was lower than the control group(all P<0.05);Serum levels of interleukin-6(IL-6),interleukin-8(IL-8)and C-reactive protein(CRP)in both groups were increased compared with those before surgery,and the test group was lower than the control group(all P<0.05).During the follow-up period,the pregnancy rate of the test group and control group was 51.47%and 42.65%,but there was no significant difference between both groups(P>0.05).Conclusion:Compared with hysteroscopic electrotomy,hysteroscopic cold knife separation can effectively regulate the levels of serum hormones and serological indicators in patients with uterine cavity adhesion,improve ovarian function,reduce body inflammation,and improve the operation indicators,endometrial thickness,uterine volume and menstrual volume of patients,thus promoting the recovery of uterine cavity morphology,and with higher pregnancy outcome.