Effectiveness Of Estrogen Treatment After Transcervical Resection Of Adhesions On Severe Uterine Adhesion Patients

Intrauterine adhesion (IUA) or intrauterine synechiae, which is also called Asherman syndrome, means the uterinecavity, the isthmus, cervical pipe of the endometrial surface partial or complete of adhesion after the uterine surgery or the operation of radiation and secondary infection. The common clinical manifestations of IUA are hypomenorrhea, amenorrhea, periodic abdominal pain, abnormal pregnancy or secondary infertility. In recent years, the prevalence of IUA has showed the rising tendency due to the increase number of abortion, there is a serious influence in the female’s physical and mental health and family harmony.At present the hysteroscopy is the primary and standard choice of diagnosis and treatment for IUA. Transcervical resection of adhesions (TCRA) can resect pertinently of uterine adhesion under direct vision, so that it can recover the normal menstrual cycle, improve the reproductive functions. However, it is easy for the uterine cavity to become re-adhesion postoperatively, especially for the severe intrauterine adhesion. There is a higher intrauterine re-adhesion rate but a lower menstrual improvement rate and pregnancy rate in the severe intrauterine adhesion than that in the mild and moderate intrauterine adhesion, so the re-adhesion TCRA postoperatively influences the main factors of curative effect. So the treatment of intrauterine adhesion, especially severe intrauterine adhesion is a large problem in the clinical work.The methods to prevent adhesion recurrence TCRA postoperative currently have placing intrauterine device (IUD), the balloon of a Foley’s catheter, biological of preventing constitution such as auto-cross-linked hyaluronic acid (ACP) gel, amnion grafting, oral estrogen or artificial cycle, fiber hysteroscopy exploration and blunt separation technique, etc. However, it is still controversial for the curative effect to prevent the adhesion recurrence for oral estrogen, and which doses and cycles of oestrogen treatment is better for the severe intrauterine adhesion patients. The investigation is to retrospectively analyze the curative effect of oral estrogen treatments on severe uterine adhesion patients after transcervical resection of adhesions, so that we can find an effective method to improve the curative effect after TCRA for clinical treatment.Materials and methodsA retrospective analysis is carried out to explore the clinical data of213cases of severe intrauterine adhesion patients who were treated in the third affiliated hospital of Zhengzhou university during the period between Jan2008and Dec2010.193cases who administrated estrogen treatments after TCRA and20cases without using any estrogen after TCRA were included in the study as observation group and control group respectively. Patients in the observation group all took estrogen postoperatively but the doses are different. The193cases of patients with oral estrogen, according to the observation group of oral estrogen types are divided into conjugated estrogen group (n=95) and estradiol valerate group (n=98). And according to the dosage, the group of conjugated estrogen treatment is divided into:a piece of group (n=43), two pieces of group (n=21), three pieces of group (n=10), four pieces of group (n=21). As the same method, according to the dosage, the group of estradiol valerate treatment is divided into:a piece of group (n=47), two pieces of group (n=22), three pieces of group (n=10), four pieces of group (n=19). All Patients were followed up to investigate their menstrual condition, adhesion recurrence, drug side effects and their pregnancy. We used the SPSS17.0statistcal software to analysis the data. One-way analysis of variance was used to analysis the numerical variable, and chi-square test were used to analysis the categorical variables, cr=0.05.Results1. The patients of menstrual improvement taking a piece to four pieces of conjugated estrogen3months after the surgery were respectively33,17,9,19, and the patients of intrauterine re-adhesion were respectively6,3,1,2. Compared with the control group(8,9), there is statistically significant difference in taking different doses of conjugated estrogen treatment with the control group, the P value were respectively0.001,0.038. While there is no statistically significant difference with the menstrual improvement rate and intrauterine re-adhesion rate in different doses of conjugated estrogen treatment(P>0.05). All patients have no serious drug side effects.2. The patients of menstrual improvement taking a piece to four pieces of estradiol valerate3months after the surgery were respectively38,18,9,15, and the patients of intrauterine re-adhesion were respectively5,3,1,2. Compared with the control group(8,9), there is statistically significant difference in taking different doses of estradiol valerate treatment with the control group, the P value were respectively0.003,0.020. While there is no statistically significant difference with the menstrual improvement rate and intrauterine re-adhesion rate in different doses of estradiol valerate treatment(P>0.05). All patients have no serious drug side effects.3. The patients of menstrual improvement taking conjugated estrogen and estradiol valerate one year after the surgery were respectively80,83. and the patients of intrauterine re-adhesion were respectively21,22. Compared with the control group(8,10), there is statistically significant difference in taking conjugated estrogen and estradiol valerate treatment with the control group, the P value were respectively0.000,0.043. While there is no statistically significant difference with the menstrual improvement rate and intrauterine re-adhesion rate in conjugated estrogen and estradiol valerate treatment(P>0.05).4. The pregnancy patients who taked conjugated estrogen and estradiol valerate after the surgery were respectively37,40. and the live births were respectively16,14. Compared with the control group(6,2), there is no statistically significant difference in taking conjugated estrogen and estradiol valerate treatment with the control group, the P value were respectively0.634,0.686.Conclusions1. Oral estrogen treatment is effective to severe uterine adhesion patients after transcervical resection of adhesions, but it can not improve the pregnancy rate.2. Oral different doses of estrogen treatment don’t improve its efficacy after transcervical resection of severe adhesions.