Clinical Research Of Growth Hormone Treatment After Transcervical Resection Of Intrauteirne Adhesions

Objective Intrauterine adhesions (IUA) is a injurious lesion of the basal layer ofendometrium after uterine cavity operation or secondary infection, which can lead to theuterine cavity of endometrium surface partial or complete adhesion, and the commonclinical manifestations are hypomenorrhea, amenorrhea, abdominal pain or poor fertility.Hysteroscopy is the gold standard for diagnosis of intrauterine adhesions. Transcervicalresection of adhesions (TCRA),under direct vision, is the primal choice of separationfor IUA. However it is easy for the uterine cavity to become re-adhesion after adhesionoperation, even need multiple surgery, therefore prevention of postoperative adhesion isa hot and important problem in clinical research. At present, the commonly usedpreventive methods include: placing intrauterine device (IUD) and balloon of Foleycatheter, which play a part as a physical barrier function. Drug therapy contains such asvasodilator, female progestational hormone, and so on. These methods play a rolecertainly, but the effect is still unsatisfactory. In his comprehensive study,on the basis ofplacing an IUD and balloon catheter in the intrauterine and combing femaleprogestational hormone cycle treatment, it add the growth hormone to evaluate thevalue of growth hormone in the prevention of intrauterine adhesions after TCRA andrecovery of endometrial.Methods We collect the clinical data of41patients who were diagnosed moderate tosevere intrauterine adhesions by hysteroscopy in our hospital from February2012toNovember2012.All patients were performed under TCRA surgery successfully.According to the different treatment after TCRA, they are divided into two groups:the test group has22cases (severe in9cases, moderate in13cases) and the control grouphas19patients (severe in5cases, moderate in14cases).The patients in both groups areall placed an IUD and a Foley balloon catheter in the intrauterine, and receive oralfemale progestational hormone therapy: estradiol validate9mg/day, a total of21days,and add medroxyprogestatione10mg/days in the last10days. The test group, using thesame measure with the control group treatment, add subcutaneous injection ofrecombinant human growth hormone4U/day×5days.Three months later, all of thepatients check the hysteroscopy and take out the IUD, evaluating the uterine cavity form,and follow-up recovery of endometrial and menses, Three months later after operation,the degree of adhesions, the changes of endometrial thickness in the menstrual period ofthe tenth day to fifteenth day and the improvement of their menstruation are record,With the statistical analysis using SPSS12.0software, average comparison use T test,comparison between both groups use the chi square and level of significance as thealpha α=0.05,P<0.05for the difference is significant.Results1Endometrial thickness compared with the preoperativeThree months later after operation, the endometrial thickness of the test group rise by anaverage of1.73mm, while the control group increased by average1.02mm. A t testshowed that the difference between both groups was statistically significant(t=2.691,P=0.01).2Situation of menstrual of patients in both groupsThree months later after operation, we follow up both groups of patients with men-strual of the test group compared with the preoperative,50.00%（11/22） patientsreturned to normal,10.94%(9/22) improved significantly, and9.52%(2/22) patients hadno obvious change; of the control group,36.84%(7/19) patients returned to normal, and52.63%(10/19) improved significantly,10.53%(2/19) patients had no significant change. The chi-square test showed the difference between both groups was notstatistically significant,(χ~2=0.729,P=0.694).3Three months later, both groups of people with hysteroscopyThree months later, all patients underwent hysteroscopy examination and taking out theIUD. The research group of63.6%(14/22) patients returned to normal uterine cavityand re-adhesion rate was36.4%(8/22),in which mild adhesion rate was27.3%(6/22),moderate adhesion rate was9.1%(8/22).While the control group of52.6%(6/22)patients returned to normal uterine cavity, and re-adhesion rate was47.4%(9/19),inwhich mild adhesion was42.1%(8/19),moderate adhesion was5.3%(1/19),Thechi-square test showed that the difference between both groups was not statisticallysignificant,(χ~2=1.077,P=0.584).Conclusion1The method that placing an IUD and a balloon catheter in the intrauterine andcombing oral female progestational hormone cycle therapy for the patients with IUAafter TCRA, can prevent re-adhesion effectively.2On the basis of this method, if adding appropriate doses of growth hormone, it caneffectively promote the growth of endometriumof intrauterine adhesion after resectionof adhesions, then improve the therapeutic effect of IUA.3The re-adhesion rate of the group with growth hormone is lower compared with thecontrol group, but the difference is not statistically significant.