Study On The Effect And Mechanism Of Kidneytonifying And Stasis-removing Method In Preventing Postoperative Re-adhesion Of Moderate-severe Intrauterine Adhesions

OBJECTIVE: To evaluate the effect of the Chinese herbal remedy for kidney deficiency and blood stasis combined with the Western artificial cycle on patients after separation of moderate-to-severe uterine adhesions and to reveal its mechanism of action,with comparative analysis in terms of menstruation,uterine adhesions,endometrium and pregnancy outcome.METHODS: A sample of 84 patients with renal deficiency and blood stasis type of uterine adhesions was targeted according to the inclusion and exclusion criteria in this study,and all patients underwent hysteroscopy-guided adhesion separation.Patients were randomly divided into two groups and both groups received post-operative sequential oestrogen and progestogen therapy,with patients in the treatment group receiving additional herbal remedies to tonify the kidney and resolve blood stasis.After 3 menstrual cycles,the treatment was compared in terms of whether menstruation,uterine adhesions,endometrium,Chinese medicine symptoms of kidney deficiency and blood stasis,expression of Transforming growth factor β1(TGF-β1)and Insulin-like growth factor IGF-1(IGF-1).The results: In terms of total efficiency,the two regimens were compared.Results: In terms of total effective rate,the treatment group and the control group were90.60% and 64.30% respectively,with the treatment group being significantly more effective and the comparison between the groups being statistically significant(p < 0.05).In terms of menstruation,uterine adhesion score,endometrial repair and reduction of the degree of kidney deficiency and blood stasis symptoms in Chinese medicine,the treatment group had better efficacy,and there was statistical significance in the comparison between groups(P < 0.05).The expression of TGF-β1 and IGF-1 in endometrial tissues decreased in both groups before and after treatment(P < 0.05),and there was no statistical significance in the comparison between groups(P > 0.05).Conclusion:(1)The combination of the Chinese herbal medicine formula for tonifying the kidney and resolving blood stasis and estrogen sequential treatment can reduce the degree of uterine adhesions and shorten the menstrual recovery cycle.(2)This combination regimen can promote the repair of damaged endometrium with kidney deficiency and blood stasis,reduce the degree of TCM symptoms,as well as improve the endocrine situation and enhance immunity.(3)From a microscopic perspective,the method of tonifying the kidney and resolving blood stasis can control the expression levels of cytokines TGF-β1 and IGF-1 to a lower range,delay the fibrosis process,avoid excessive tissue adhesions,promote the restoration of pelvic blood flow,accelerate endothelial repair,prevent re-adhesion and improve the possibility of pregnancy.