免扩宫宫腔镜技术与HEOS宫腔镜技术对宫腔粘连分离术的应用对比

Application of non-cervical dilation hysteroscopic technique versus HEOS hysteroscopic technique in intrauterine adhesion separation

目的探讨不同宫腔镜技术在宫腔粘连(IUA)患者治疗中的应用价值以及对血管功能指标的影响。方法选取2021年6月—2022年12月102例IUA患者为研究对象,根据随机数字表法分为2组,每组51例。2组均采用宫腔镜冷刀分离术,观察组采用免扩宫宫腔镜技术,对照组采用HEOS宫腔镜技术。观察2组手术相关指标、手术疗效、月经改善情况以及手术前后应激反应、血管功能相关因子、子宫内膜血流,同时记录2组术后并发症以及随访1年复发和临床妊娠情况。结果观察组手术时间短于对照组,术中失血量少于对照组,差异有统计学意义(P<0.05)。观察组手术治疗总有效率与对照组比较,差异无统计学意义(P>0.05)。观察组月经总改善率高于对照组,差异有统计学意义(P<0.05)。2组术后24 h肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平较术前升高,术后48 h较术后24 h下降,且观察组术后24、48 h均低于对照组,差异有统计学意义(P<0.05)。术后1、3个月,2组血清缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)、金属蛋白酶组织抑制物-1(TIMP-1)水平较术前下降,且观察组低于对照组,差异有统计学意义(P<0.05)。术后1、3个月,2组血管化-血流指数(VFI)、血流指数(FI)、血管指数(VI)较术前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组随访1年临床妊娠率高于对照组,差异有统计学意义(P<0.05)。结论免扩宫宫腔镜技术与HEOS宫腔镜技术治疗中度IUA均有较好的临床效果和安全性,但前者能优化操作流程,减轻围术期应激反应,改善患者血流动力学及月经状态。

Objective To investigate the application value of different hysteroscopic techniques in the treatment of intrauterine adhesions(IUA)and their effects on vascularfunction indicators.Methods A total of 102 patients with IUA from June 2021 to December 2022 were selected as study subjects and divided into two groups based on the random number table method,with 51 patients in each group.Both groups underwent hysteroscopic cold knife adhesiolysis.The observation group adopted non-cervical dilation hysteroscopic technique,while the control group adopted HEOS hysteroscopic technique.Surgical-related indicators,surgical efficacy,menstrual improvement as well as stress response before and after surgery,vascular function-related factors,and endometrial blood flow were observed in both groups.Postoperative complications,recurrence,and clinical pregnancy within 1-year follow-up were also recorded.Results The operative time in the observation group was shorter,and the intraoperative blood loss was less than that in the control group(P<0.05).There was no statistically significant difference in the total effective rate of surgical treatment between the observation group and the control group(P>0.05).The total improvement rate of menstruation in the observation group was higher than that in the control group(P<0.05).Levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and interleukin-6(IL-6)increased at 24 hours after surgery and decreased at 48 hours after surgery compared with levels at 24 hours after surgery in both groups.Additionally,the observation group had lower levels than the control group at 24 and 48 h after surgery(P<0.05).At 1-and 3-month after surgery,serum hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF),and tissue inhibitor of metalloproteinase-1(TIMP-1)levels decreased compared with pre-surgery levels in both groups,with the observation group showing lower levels than the control group(P<0.05).At 1-and 3-month after surgery,vascularization index(VI),flow index(FI),and vascularization flow index(VFI)increased compared with pre-surgery levels in both groups,with the observation group showing higher levels than the control group(P<0.05).The clinical pregnancy rate at 1-year follow-up in the observation group was higher than that in the control group(P<0.05).Conclusion Both non-cervical dilation hysteroscopic technique and HEOS hysteroscopic technique have good clinical effects and safety in the treatment of moderate IUA,but the former can optimize the operation process,reduce perioperative stress response,and improve patients'hemodynamics and menstrual status.