Effects Of Two Kinds Of Transcervical Resection Of Intrauterine Adhesions On Morphology And Function Of Human Endometrium

Objective: To invetigate the effects of two kinds of different transcervical resection of intrauterine adhesions on the shape and the function of endometrium,and explore more reasonable surgical methods and probe into the causes of the occurrence of intrauterine adhesions and the mechanism of endometrial repair.Methods: Forty patients with mild to moderate intrauterine adhesions treated in Zunyi Maternal and Child Health Care Hospital between December 2015 and June 2016 were randomly divided into 2 groups based on the date of diagnosis(odd and even numbers): 1 group(n=20;undergoing hysteroscopic electroresection to separateadhesions)and 2 group(n=20;receiving metal curved hook under hysteroscope to separateadhesions).One to three months before and after the surgery,the menstruation,the endometrial thickness,the shape and the size of the uterine cavity,the number of endometrial cells,the expression of estrogen receptor(ER),platelet endothelial cells adhesion molecules(CD31),the transforming growth factor-?1(TGF-?1)and the leukemia inhibitory factor(LIF)in the endometrium were observed and compared in the two groups.Results: 1.After treatment,both of the 1 and 2 groups showed good improvement rates(P<0.05)in menstruation cycle,endometrial thickness and uterine cavity morphology,without significant difference between the two groups(P>0.05).There was a significant difference in basic improvement of the uterine cavity morphology between the two groups(P<0.05),1 group being better than that of 2 group.2.Compared with that before treatment(P<0.05),both in 1 and in 2 groups the number of endometrial gland cells significantly declined,with no significant difference between the two groups(P>0.05).3.After treatment,both groups presented significantly different expression levels in ER,TGF-?1,CD31 and LIF(P<0.05),without significant difference(P>0.05)between 1 and 2 groups.Compared with the levels before treatment,ER and TGF-?1showed a descending trend,CD31 and LIF showed an ascending trend.Conclusion: 1.In the treatment of mild to moderate intrauterine adhesions,the two kinds of hysteroscopy surgery both showed satisfactory results during the observation period of one-to-three months,with no significant difference in efficacy between the two groups.While the 2 group was better than the 1 group in basic improvement of the uterine cavity morphology,which might be due to the dilatation of inner cervical canal and repeated friction between electric resectoscope and inner cervical canal.Therefore,it is necessary to improve the instruments for the improvement of operation efficacy.2.Both kinds of surgery led to decreased endometrial gland cells in a short period after operation,which may be associated with the second trauma caused by surgery.3.Both kinds of surgery could improve the functional state of endometrium by decreasing uterine adhesions and fibrosis degrees through down-regulation of ER and TGF-?1 expression,as well as increasing uterine angiogenesis and uterine receptivity through up-regulation of CD31 and LIF expression.