The Clinical Analysis Of TCRA Plus Adjuvant Therapy On Intrauterine Adhesion

ObjectivesThrough the retrospective analysis of the clinical data of patients with intrauterine adhesions in our hospital,we can understand the clinical characteristics,treatment methods and risk factors of intrauterine adhesions in this area.Follow-up study was carried out on patients with intrauterine adhesions who underwent TCRA.The efficacy and prognosis of three different adjuvant treatment schemes for moderate and severe IUA patients after TCRA were analyzed,which provided scientific basis for the treatment of clinical IUA in this area.MethodsA total of 182 patients who underwent hysteroscopic surgery for the diagnosis of intrauterine adhesions in our hospital from June 2013 to June 2016 were retrospectively analyzed.Through the retrospective analysis of the clinical data of patients with intrauterine adhesions.The clinical data of patients were analyzed to understand the clinical characteristics,treatment methods and risk factors.To lay a foundation for the efficacy and prognosis of three different adjuvant therapies for patients with moderate and severe IUA after TCRA.In the first part,patients with mild to moderate adhesion were divided into two groups:mild adhesion group?47 cases?and moderately severe adhesion group?135 cases?.The clinical data of the two groups were mainly included:age,complaint,diagnosis,disease course,degree of education,age of menarche,parity,the number of induced abortions,the history of diagnosis of curettage,the history of secondary uterus,the history of uterine submucous myoma,the history of infection during pregnancy,the history of endometrial polyp,etc.Logistic regression analysis will be used after?² test.In the second part,patients with moderate to severe intrauterine adhesions who underwent TCRA surgery?135 cases?were followed up for 2 years.They were divided into three groups according to the treatment methods after TCRA?groups A,B,and C?.Group A patients?45 cases?example:Place intrauterine device after TCRA+sodium hyaluronate+Oral estrogen and progesterone,group B?48 cases?example:placed intrauterine device+oral estrogen and progesterone after TCRA,group C?42 cases?example:after TCRA,sodium hyaluronate+oral estrogen and progesterone were placed,and the second uterine probing,menstruation and pregnancy outcome were compared between the three groups.ResultsThe first part,?² test results showed age,age of menarche,duration of disease,degree of education,parity,the history of infection during pregnancy,the history of endometrial polyp,there was no significant difference between the two groups.?P>0.05?.the number of induced abortions,the history of diagnosis of curettage,the history of secondary uterine,and the history of uterine submucous myoma were statistically significant?P<0.05?.Logistic regression analysis showed that the influencing factors of the number of induced abortions?OR=2.617,P=0.020?,diagnosis of curettage?OR=4.965,P=0.020?,and the history of secondary uterine?OR=4.629,P=0.010?were statistically significant?P<0.05?about moderately severe adhesion patients.The number of induced abortions was a multi-category independent variable,so the classification covariate treatment would be carried out,and the number of artificial abortions?1 time was compared with the number of induced abortions by 2 times,3 times,?4 times,and the results showed that the risk of moderately severe adhesions increased with the number of induced abortions,and the difference was statistically significant?P<0.05?.It indicated that the increased of the number of induced abortions was a risk factor for patients with moderately severe adhesions.At the same time,the history of diagnosis curettage,the history of secondary uterine disease was also a risk factor for patients with moderately severe adhesions.That means,the number of induced abortions,the history of diagnosis of curettage,and the history of secondary uterine disease were risk factors for moderately severe adhesions.The second part,group A,B,C,three groups of patients after 3 months of treatment,to the hospital for review,used hysteroscopy to observe the intrauterine adhesions and menstrual improvement,Three months after treatment,the shape of uterine cavity in the three groups was?²=7.843,P=0.023?P<0.05?,the difference was statistically significant.?₁=0.017?0.05/3?,group A compared with group B,?²=4.232,P=0.040?P>0.017?.group B compared with group C?²=0.757,P=0.384?P>0.017?.group A compared with group C,?²=7.911,P=0.005?P<0.017?.The menstrual status of the three groups after 3 months of treatment was?²=10.314,P=0.006?P<0.05?,the difference was statistically significant.The test level was?₁=0.017,?²=5.147,P=0.023 in group A and group B?P>0.017?.Compared group C and group B?²=1.244,P=0.265?P>0.017?.group A compared with group C,?²=10.467,P=0.001?P<0.017?.Among the follow-up data of patients with pregnancy intention,no contraception and non-adhesive uterine cavity,40patients in group A,25 was pregnancy,and 15 was non-pregnancy.There were 36 patients in group B,15 was pregnancy,and 21 was pregnancy.There were 34 patients in group C,10 was pregnancy,and 24 was pregnancy.Pregnancy was compared between the three groups after 2 years of treatment,?²=8.425,P=0.015?P<0.05?,the difference was statistically significant.Group A compared with group B,?²=3.299,P=0.069?P>0.05?,the difference was not statistically significant.Group B compared with group C,?²=1.144,P=0.285?P>0.05?,the difference was not statistically significant.Group A compared with group C,?²=8.072,P=0.004?P<0.05?,and the difference was statistically significant.Conclusions 1 The more times of induced abortion,the history of diagnosis of curettage,and the history of secondary uterine disease are risk factors for moderately severe adhesions.2 The uterine morphology and menstrual status of patients with moderately severe adhesions after TCRA were improved for 3 months,there was difference between groups A,B and C,Pairwise comparison,group A was better than Group B.3 Auxiliary treatment after TCRA can improve fertility.The adjuvant therapy of intrauterine device+sodium hyaluronate+oral estrogen and progesterone after TCRA is better than that sodium hyaluronate+oral estrogen and progesterone after TCRA at the 2 years of pregnancy.Figure 0;Table 9;Reference 83...