| Objective:Hysteroscopic blunt and micro scissor separation were performed on uterine cavity adhesion tissues of patients with mild and moderate IUA,low dose estrogen was orally taken after operation to strengthen endometrial repair.The clinical efficacy of uterine cavity adhesion was observed.The expression change of TGF-?1 and gland count in the endometrium of patients before and after medication were observed,so as to explore the therapeutic mechanism of estrogen on IUA and provide theoretical basis for clinical use.Methods:Sample collection:From March 2017 to December 2018,patients diagnosed with IUA under hysteroscopy in the Gynecological Outpatient Department of Yan 'an University Affiliated Hospita.Among them,30 patients in the mild group and 30 in the moderate group were taken as the observation group,and 30 patients endometrium with tubal infertility(the endometrium is healthy and lesions)were taken as the control group.Therapeutic schemes:Complete data of selected patients were collected,and hysteroscopic separation surgery of intrauterine adhesion tissue was performed with blunt and micro scissors.After finished the surgery,the patients were demanded to take pentanoic acid estradiol tablets 3mg per day for 21 days from now on.After 10 days,the progestin capsule was added 200 mg per day,and stoped taking the medicine at the same time,kept 3 consecutive artificial cycle,inquired about menstrual quantity at postoperative 1,2,3 month,then evaluated the menstrual curative effects;Reviewed by hysteroscopy at 3 months postoperatively(3-7 days after drug withdrawal for the patients with amenorrhea).The objectives are to observe the uterine cavity morphology,evaluate the curative effects and specimens obtaining.A small amount of endometrium adjacent to the adherent tissue was scraped at the first time surgery and having the hysteroscope review at the 3 months after surgery.The obtained endometrium was embedded with paraffin,and the expression of TGF-?1 in the endometrium before and after the treatment was detected by two-step immunohistochemical,and the endometrium glands were observed by HE staining method.SPSS22.0 statistical software was used to analyze the experimental data.Results:1.Before treatment,the expression of TGF-?1 in the endometrium of the mild group(2.21±0.36)and the moderate group(3.15±0.39)was higher than that of the control group(1.92±0.19),and the difference was statistically significant(P < 0.05).The expression of TGF-?1 in the moderate group was higher than that in the mild group(P<0.05).2.Before treatment,the number of endometrial glands in the mild group(5.82±0.23)and the moderate group(3.61±0.45)was fewer than that in the control group(7.81±0.42),with statistically significant differences(P < 0.05).There were also differences in the number of glands between the mild group and the moderate group,and the moderate group had fewer glands(P<0.05).3.The postoperative efficacy of the mild group was as follows:a.the cure rate at the third month after intrauterine adhesion surgery was90%,and the improvement rate was10%;inefficiency was0%;b.condition of menstrual blood volume at postoperative 1,2,3months:the cure rate was33.33%,90%,96.67%,respectively;the improvement rate was56.67%,10%,3.33%,and the ineffective rate was10%,0% and 0%,respectively.The postoperative efficacy of the moderate group was as follows:a.The cure rate at the third month after intrauterine adhesion surgery was76.67%.The improvement rate was 23.33% and the inefficiency was0%.b.the condition of menstrual blood volume at postoperative 1,2,3 months:the cure rates were 30%,70% and 80%,respectively;the improvement rate were 50%,23.33% and 20% respectively,inefficiencies were 20%,6.67%,and0%,respectively.In terms of the prognosis of intrauterine adhesion,the efficacy between the two observation group had no significant difference(P>0.05).In terms of the recovery of menstrual volume,the curative effect of mild group was better than that of moderate group at 2 and 3 months after surgery(P <0.05).4.Before and after the treatment,the expression of TGF-?1 in the endometrium of the mild group(3.61±0.45)and the moderate group(4.52±0.69)in the observation group was statistically different(P <0.05).5.After treatment,the number of glands in the endometrium of the mild group(8.18±0.87)and the moderate group(7.21±1.28)increased compared with that before treatment,and the difference was statistically significant(P <0.05).Conclusion:1.The expression of TGF-?1 in endometrial of IUA patients increased,and was positively associated with the degree of clinical adhesion;2.Endometrial glands decreased in IUA patients before treatment,and treatment with 3 mg estrogen per day could increase the Endometrial glands;3.In the prevention of recurrence of intrauterine adhesions,there was no significant difference in the efficacy between the mild group and the moderate group.In the recovery of menstrual volume,the mild group was better than the moderate group.4.Estrogen can up-regulate the expression of TGF-?1 in the endometrium of patients with IUA after intrauterine adhesions.5.The effect of estrogen on intrauterine adhesions is not achieved by lowering TGF-?1. |
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