| Purpose:intrauterine adhesion(IUA)is a kind of endometrial lesions caused by various reasons which lead to partial or complete intrauterine atresia and endometrial shedding.The obstetric complications induced by it,such as placental adhesion,placental previa,and repeated abortion,often cause serious effects on the physical and mental health of women of child-bearing age.At the same time,with the increase of the number and frequency of intrauterine operations such as abortion and curettage,the diagnostic rate and incidence rate of intrauterine adhesions are on the rise.However,the cure rate of IUA and the pregnancy rate after adhesions are still relatively low.Currently,the Transcervical resection of adhesions(TCRA)is mainly adopted,at the same time,foley balloon is placed postoperatively,or high doses of estrogen are taken for comprehensive treatment of IUA.It is found that the probability of re-adhesion is still high after TCRA surgery(especially in patients with severe adhesion).Therefore,it is of great theoretical and practical significance to explore the efficacy and mechanism of different treatment methods for TCRA postoperative re-adhesion,and to seek new therapeutic targets to inhibit the occurrence of endometrial fibrosis.In addition,it is important for the prevention and treatment of continuous intrauterine adhesion.Methods:a total of 160 patients with moderate to severe intrauterine adhesion treated with TCRA in GuangZhou First People's hospital from June 2018 to February2019 were selected as the study subjects after retrospective analysis.According to the different postoperative treatment methods of TCRA,patients were randomly divided into 4 groups using the random number table method:patients with postoperative intrauterine foley balloon(group A),patients given postoperative artificial period(group B),patients without any postoperative processing(group C),and patients given postoperative foley balloon combined with artificial period(group D),with 40patients in each group.The menstrual volume and the incidence of intrauterine adhesion in the four groups were compared under different postoperative treatment methods.The coagulation function,liver function,blood lipid,serum,and expression of estrogen receptor(ER),matrix metallo proteinase-9(MMP-9),and transforming growth factor-?1(TGF-?1)in endometrial tissue of patients before and after treatment were observed.Results:I.After 1 cycle of postoperative TCRA treatment with different treatment methods,the menstrual volume of patients in the four groups increased significantly compared with that before treatment(P<0.05).In the 3 postoperative treatment cycles,the amount of menstrual flow in group D was significantly higher than that in other groups,while the amount of menstrual flow in group C was the lowest among the four groups in the 3 treatment cycles.There was a significant difference in menstrual volume between group D and group C(P<0.05).II.The menstrual improvement rate was 92.5%in group D,87.5%in group B,82.5%in group A,and 75%in group C after 3 cycles of treatment.Compared with before treatment,there was a significant difference in menstrual improvement rate in group D and group B after 3 cycles of treatment(?~2=5.012,P=0.023<0.05).There was a significant difference in menstrual improvement rate between group D and group C after 3 cycles of treatment(?~2=4.746,P=0.0098<0.001).III.After 3 cycles of postoperative TCRA treatment,hysteroscopic observation of some patients in group A,group B,and group C showed that there were still different degrees of fibrous scars on the wound surface of the uterus,with thin endometrium.The morphology of the intrauterine of patients in group D basically returned to normal under hysteroscopy observation.IV.After 3 cycles of treatment with different treatment methods,in group D,92.5%of the patients had normal uterine cavity morphology,and there was no severe adhesion.Only 57.5%of patients in group C had normal uterine cavity,and 7.5%had severe adhesion.The patients in group B and group A with normal uterine cavity morphology accounted for 82.5%and 72.5%respectively,and the rate of severe adhesion in both groups was 2.5%.The intrauterine adhesion status of group D was significantly different from that of group C(P<0.05).The re-adhesion rate was 7.5%in group D,17.5%in group B,27.5%in group A,and 42.5%in group C,respectively.Compared with group C,the rate of intrauterine re-adhesion in group D was significantly different(P=0.0083<0.01).The rate of intrauterine re-adhesion in group D was significantly different from that in group B and group C(P<0.05),which was statistically significant.V.After 3 treatment cycles,there was no significant difference in PT,APTT,TT,and FIB between the four treatment methods(P>0.05).At the same time,no skin ecchymosis,bleeding point,thrombotic disease,and other symptoms or signs were found in all patients during the medication and follow-up period.VI.After 3 cycles of treatment,for the liver function indexes before and during treatment(3 cycles)of the four groups of patients,from the first treatment cycle,the liver function indexes of ALT,AST,?-GGT,ALP,and TBIL in group B and group D all showed an upward trend.After 3 cycles of treatment,there was no significant difference in all liver functions compared with those before surgery(P>0.05).However,the liver function indexes of ALT,AST,?-GGT,ALP,and TBIL in group A and group C did not change compared with those before surgery,and there was no significant difference after three treatment cycles compared with other two groups(P>0.05).VII.From the first treatment cycle,there was no change in HDL-C in patients in group A and group C compared with those before surgery.The HDL-C index of patients in group B and group D showed a trend of continuous decline,and although there was a decrease after 3 treatment cycles compared with before treatment,there was no significant difference between the two groups(P>0.05).After treatment,there was no significant difference in serum lipid indexes of TC,TG,HDL,and LDL in all patients compared with those before treatment(P>0.05).Moreover,blood lipid indexes TC,TG,HDL,and LDL were all in the normal range.VIII.After 3 treatment cycles,MMP-9 levels in serum and endometrial tissues of all patients increased significantly,and MMP-9 levels in serum and endometrial tissues of group D were the highest among the four groups.The level of MMP-9 in group C was the lowest among the four groups,and there was a significant difference between group D and group C of MMP-9 levels in serum and endometrial tissue(P<0.05).IX.After 3 treatment cycles,the TGF-?1 levels in serum and endometrium of all patients showed a trend of decline.The TGF-?1 levels in serum and endometrium of patients in group D were the lowest among the four groups.There were significant differences of TGF-?1 levels in serum and endometrial between group D and group C(P<0.05).X.After 3 cycles of treatment,compared with before treatment,there was no significant difference in serum ER level and endometrial tissue ER level in group C(P>0.05),and its serum ER level was the lowest among the four groups.The serum ER level of the other three groups all showed an upward trend,with the most significant increase of the serum ER level in group D.Serum ER levels in of patients in group A,group B,and group D were significantly different from those before treatment(P<0.05).After 3 treatment cycles,the serum ER level of patients in group C was significantly lower than that in other three groups,and the serum ER level of patients in group B and group D was significantly different from that in group C(P<0.05).XI.The cure rates of group A,group B,group C,and group D were 57.5%,67.5%,50%,and 82.5%,respectively after 3 treatment cycles according to different treatment methods.The effective rates of group A,group B,group C,and group D were 82.5%,87.5%,72.5%,and 95%,respectively.There was a significant difference in the effective rate between group D and group C,and the difference was statistically significant(P<0.05).Conclusion:I.All the four treatment methods had preventive effect on TCRA postoperative re-adhesion,and foley balloon combined with artificial period therapy had the best preventive effect.II.The possible mechanism of the preventive effect of estrogen alone supplementation on post-TCRA re-adhesion was that estrogen supplementation up-regulated the ER expression in serum and endometrial tissues.III.The possible mechanism of Foley balloon combined with artificial cycle for the prevention of postoperative re-adhesion of TCRA was that the combination of the two caused changed the contents and expressions of ER,MMP-9,and TGF-?1 in serum and endometrial tissues. |
PDF Full Text Request