粒细胞刺激因子促进宫腔粘连分离术后子宫内膜修复的疗效

Efficacy of granulocyte colony-stimulating factor in promoting endometrial repair after intrauterine adhesion separation surgery

目的探讨中重度宫腔粘连术后宫腔灌注粒细胞刺激因子促进子宫内膜修复的临床疗效。方法回顾性分析2021年6月至2023年12月因中重度宫腔粘连在河北生殖妇产医院妇科行宫腔镜下宫腔粘连分离术的58例患者的临床资料,根据术后是否应用粒细胞刺激因子分为粒细胞集落刺激因子(G-CSF)组(35例)和对照组(23例)。比较2组患者手术前后子宫内膜厚度、月经改善、粘连复发情况以及妊娠结局。结果①比较2组子宫内膜厚度术后均较术前增加(P<0.01),且比较2组术后的子宫内膜厚度G-CSF组患者较对照组厚[(7.14±1.45)mm和(6.08±2.13)mm],差异有统计学意义(P<0.05)。②2组患者术后月经改善情况比较,G-CSF组优于对照组(91.4%和65.2%),差异有统计学意义(P<0.05);2组粘连复发情况比较,差异无统计学意义(P>0.05)。③对2组进行生育分析,G-CSF组与对照组妊娠率(37.1%和26.1%),2组累计妊娠率比较差异无统计学意义(P=0.127)。手术到受孕的中位持续时间G-CSF组为11个月[95%CI(8.8,13.1)],对照组为19个月[95%CI(19.7,22.5)]。结论宫腔灌注粒细胞刺激因子辅助宫腔镜下宫腔粘连分离术(TCRA)治疗中重度宫腔粘连(IUA),可促进术后子宫内膜修复,增加子宫内膜厚度及月经量,未降低宫腔粘连复发率。

Objective To explore the clinical efficacy of intrauterine infusion of granulocyte colony-stimulating factor(G-CSF)in promoting endometrial repair after hysteroscopic adhesions for moderate to severe intrauterine adhesions.Methods A retrospective analysis was conducted on the clinical data of 58 patients who underwent hysteroscopic adhesions for moderate to severe intrauterine adhesions at Hebei Maternity Hospital from June 2021 to December 2023.All the patients were divided into a G-CSF group(35 cases)and a control group(23 cases)based on whether G-CSF was used postoperatively.The endometrial thickness,menstrual improvement,adhesion recurrence,and pregnancy outcomes before and after surgery were compared between the two groups.Results①The endometrial thickness of both groups after surgery increased compared to before surgery(P<0.01),and the endometrial thickness of patients in the G-CSF group after surgery was thicker than that of the control group[(7.14±1.45)mm vs(6.08±2.13)mm],with a statistically significant difference(P<0.05).②The postoperative menstrual improvement in the G-CSF group was better than that in the control group(91.4%vs 65.2%),and the difference was statistically significant(P<0.05);There was no statistically significant difference in adhesion recurrence between the two groups(P>0.05).③The fertility analysis results were limited to two groups,with pregnancy rates of 37.1%in the G-CSF group and 26.1%in the control group;There was no statistically significant difference in the cumulative pregnancy rate between the two groups(P=0.127).The median duration from surgery to conception in the G-CSF group was 11 months 95%CI(8.8,13.1),while in the control group it was 19 months 95%CI(19.7,22.5).Conclusion Intrauterine infusion of G-CSF assisted hysteroscopic adhesions for the treatment of moderate to severe intrauterine adhesions can promote postoperative endometrial repair,increase endometrial thickness and menstrual flow,without reducing the recurrence rate of intrauterine adhesions.