中度宫腔粘连患者术后应用富血小板血浆宫腔灌注联合雌孕激素治疗的效果观察

Observation on the Effect of Postoperative Application of Platelet-rich Plasma Uterine Perfusion Combined with Estrogen and Progesterone Treatment in Patients with Moderate Uterine Adhesions

目的:探讨应用富血小板血浆(PRP)宫腔灌注联合雌孕激素治疗中度宫腔粘连(IUA)术后患者的临床效果。方法:选取2022年6月—2023年12月揭阳市揭西县人民医院收治的中度IUA患者60例作为研究对象,按照随机数字表法分为对照组和观察组,各30例。两组均行宫腔镜下粘连分离术(TCRA),对照组术后给予雌孕激素治疗,观察组在对照组基础上联合PRP宫腔灌注治疗。比较两组月经改善情况、子宫内膜下血流参数[血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)]、子宫内膜容受性[子宫内膜厚度(ED)、子宫内膜容积(EV)]、复发情况及不良反应。结果:观察组月经复潮时间短于对照组,月经量多于对照组,经期时间长于对照组,差异有统计学意义(P<0.001);治疗后,两组VI、FI、VFI均升高,且观察组高于对照组,差异有统计学意义(P<0.05);治疗后,两组ED、EV均升高,且观察组高于对照组,差异有统计学意义(P<0.05);观察组复发率低于对照组,差异有统计学意义(P=0.044);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:应用PRP宫腔灌注联合雌孕激素治疗,可预防中度IUA患者术后发生再次粘连,有效改善患者月经情况及宫腔形态。

Objective:To investigate the clinical effect of the application of platelet-rich plasma(PRP)uterine perfusion combined with estrogen and progesterone in the treatment of postoperative patients with moderate uterine adhesions(IUA).Methods:Sixty patients with moderate IUA admitted to Jieyang Jiexi County People's Hospital from June 2022 to December 2023 were selected as study subjects and divided into a control group and an observation group of thirty cases each according to the randomized numerical table method.Both groups underwent hysteroscopic adhesion separation operation(TCRA),the control group was given estrogen and progesterone treatment after the operation,and the observation group was combined with PRP uterine perfusion treatment on the basis of the control group.The two groups were compared in terms of menstrual improvement,sub-endometrial blood flow parameters[vascularization index(VI),blood flow index(FI),vascularization flow index(VFI)],endometrial tolerance[endometrial thickness(ED),endometrial volume(EV)],recurrence and adverse reactions.Results:The time of menstrual recurrence in the observation group was shorter than that in the control group,the amount of menstrual flow was more than that in the control group,and the duration of menstrual period was longer than that in the control group,and the difference was statistically significant(P<0.001);after the treatment,the VI,FI,and VFI of the two groups were elevated,and the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05);after treatment,ED and EV were elevated in both groups,and the observation group was higher than the control group,the difference was statistically significant(P<0.05);the recurrence rate of the observation group was lower than that of the control group,the difference was statistically significant(P=0.044);the incidence rate of adverse reactions in the two groups was compared,and the difference was not statistically significant(P>0.05).Conclusion:The application of PRP uterine perfusion combined with estrogen and progestogen treatment can prevent the occurrence of re-adhesion after operation in patients with moderate IUA,and effectively improve the patients'menstrual situation and uterine cavity morphology.