| Intrauterine adhesions（IUA）,also known as Asherman syndrome,is a gynecological disease caused by endometrial injury,which results in partial or complete occlusion of the uterine cavity and/or cervix,resulting in abnormal menstruation,infertility and repeated abortion.Transcervical resection of adhesions（TCRA）is the main surgical treatment for intrauterine adhesion at present.With the improvement of hysteroscopy technique and the application of postoperative adjuvant therapy,the diagnosis and treatment of intrauterine adhesions have made some progress.However,the prognosis of moderate and severe intrauterine adhesions is not as good as that of mild intrauterine adhesions,especially the recurrence rate of severe intrauterine adhesions is high.How to improve the prognosis of patients with moderate or severe intrauterine adhesions is a great challenge in clinical work.Hysteroscopy is the gold standard for diagnosing intrauterine adhesions.Patients with intrauterine adhesions of the same grade under hysteroscopy have different prognosis such as postoperative endometrial recovery and pregnancy outcome.Considering the reasons,patients with the same grade under hysteroscopy have the same degree of intrauterine lesions,and the different depth of involvement of lesions under the endometrium may be the reason for the different prognosis.Injury of a subendometrial structure may affect endometrial proliferation and pregnancy success.In 1983,when studying female pelvic magnetic resonance imaging,Hricak et al.found on T2 weighted image that there was a low-signal zone between the high-signal endometrium and medium-signal muscular layer of uterine wall,and named the low-signal zone as the junctional zone（JZ）.The uterine junctional zone is adjacent to the endometrial layer,which is the inner third of the muscle layer,and its thickness is no more than 5mm.It is closely related to fertilization and embryo implantation,and it intertransforms with the endometrial stromal cells.Maubon et al.found that when the average thickness of the junctional zone was greater than 7mm or the maximum thickness was greater than 10mm,the rate of embryo implantation failure was significantly increased.Therefore,whether the uterine junctional zone is abnormal may be an important factor affecting the prognosis.At present,there are few studies on the relationship between the junctional zone and the prognosis of intrauterine adhesions.This topic is to study the correlation between abnormal uterine junctional zone and the prognosis of moderate and severe intrauterine adhesions,so as to provide a new direction for evaluating the prognosis of patients.At the same time,this topic aims to find out the risk factors of poor prognosis by analyzing the influencing factors of intrauterine adhesions,so as to pay attention to these factors and improve the prognosis of patients with intrauterine adhesions.Objective1.By comparing the postoperative endometrial thickness,uterine cavity and menstrual improvement,number of separating adhesions,and pregnancy status of patients with normal and abnormal uterine junctional zone,the influence of abnormal uterine junctional zone on the prognosis of intrauterine adhesions is explored,so as to provide a new indicator for evaluating the prognosis of patients with intrauterine adhesions.2.By analyzing the influence factors of poor prognosis after transcervical resection of adhesions,the risk factors for poor prognosis is obtained.These factors should be controlled and prevented clinically so as to improve the prognosis of patients with intrauterine adhesions.Methods1.Clinical data of 82 patients with intrauterine adhesions who underwent pelvic magnetic resonance imaging（MRI）and TCRA treatment in the Third Affiliated Hospital of Zhengzhou University from December 2018 to September 2019 were retrospectively analyzed.There were 40 patients with moderate IUA and 42 patients with severe IUA.According to whether the junctional zone were abnormal on T2WI in preoperative magnetic resonance imaging examination,the patients were divided into 24 cases of moderate normal IUA group（group A）,16 cases of moderate abnormal IUA group（group B）,20 cases of severe normal IUA group（group C）and 22 cases of severe abnormal IUA group（group D）.The endometrial thickness,improvement of uterine cavity and menstruation,number of separating adhesions and pregnancy after operation were compared between group A and group B,group C and group D,and group A and group C.using the statistical software SPSS25.0 to analyze the data,the measurement data of two independent samples were measured by t test,and Counting data were tested by chi-square test.P<0.05 was considered statistically significant.2.A total of 112 patients with intrauterine adhesions who underwent TCRA in the Third Affiliated Hospital of Zhengzhou University from November 2018 to November 2019 were selected as the research subjects.Hysteroscopy was performed 3 to 7 days after the second menstruation,and the menstrual status of the patients after surgery was followed up.Menstrual volume and uterine cavity recovery after operation were used as the evaluation criteria of clinical efficacy,which were divided into improved and ineffective cases.The invalid cases are the cases with poor prognosis.The possible influencing factors of poor prognosis,such as the patient’s age,course of disease,preoperative menstrual volume,number of induced abortion,degree of adhesion and operation time,were analyzed by univariate analysis,and the counting data were tested by chi-square test.Logistic regression analysis was performed for the factors with statistically significant differences.P<0.05 was considered statistically significant.Results1.The ages of group A,B,C and D were（31.58±2.69）years old,（31.00±2.22）years old,（31.70±3.33）years old and（31.09±3.74）years old,respectively.The menstrual cycles were（30.96±3.58）days,（31.00±4.60）days,（29.35±2.28）days and（30.14±2.70）days,respectively.The number of pregnancies were（2.42±1.18）times,（1.75±1.24）times,（3.15±1.50）times and（2.41±1.18）times,respectively.The number of curettage were（1.92±0.97）,（1.25±1.18）,（2.40±1.23）and（2.14±1.32）times,respectively.There was no statistical significance in preoperative age,menstrual cycle,number of pregnancy and curettage between group A and group B,group C and group D,and group A and group C（P>0.05）.2.At the 17th day of the first artificial cycle after surgery,the endometrial thickness of group A,group B,group C and group D was（5.50±0.91）mm,（3.30±0.83）mm,（5.43±0.93）mm and（2.97±0.73）mm,respectively.The endometrial thickness in group A was higher than that of group B,and group C was higher than that of group D,and the differences were statistically significant（P<0.05）.There was no significant difference in endometrial thickness between group A and group C（P>0.05）.The endometrial thickness of group A,group B,group C and group D at 3 days after the second menstruation was（5.20±0.54）mm,（3.61±0.40）mm,（4.69±0.49）mm and（3.51±0.38）mm,respectively.The endometrial thickness of group A was higher than that of group B,group C was higher than that of group D,and group A was higher than that of group C,and the differences were statistically significant（P<0.05）.3.As for the effect of postoperative uterine cavity recovery,there were 18 improved and 6 invalid cases in group A,14 improved and 2invalid cases in group B,17 improved and 3 invalid cases in group C,and13 improved and 9 invalid cases in group D,respectively.There was no statistical significance in the improvement rate of uterine cavity between group A and group B,group C and group D,and group A and group C（P>0.05）.4.There were 3 cases in group A,6 cases in group B,5 cases in group C,and 8 cases in group D with more than one separation adhesion,respectively.There was no statistical significance in the number of separating adhesions between group A and group B,between group C and group D,and between group A and group C（P>0.05）.5.In group A,15 cases were improved and 9 cases were ineffective;in group B,10 cases were improved and 6 cases were ineffective;in group C,14 cases were improved and 6 cases were ineffective;in group D,13 cases were improved and 9cases were ineffective.There was no statistical significance in the improvement rate of menstrual volume between group A and group B,between group C and group D,and between group A and group C（P>0.05）.6.The number of pregnant women in groups A,B,C and D was 12,3,10 and 4,respectively.The pregnancy rate in group A was higher than that in group B,and that in group C was higher than that in group D,and the differences were statistically significant（P<0.05）.There was no significant difference in pregnancy rate between group A and group C（P>0.05）.7.Among the 112 patients with intrauterine adhesions,25 cases（22.3%of the total）had poor prognosis.Univariate analysis of the adverse prognosis of patients with intrauterine adhesions showed that the poor prognosis was not significantly related to age and operation time（P>0.05）.The course of disease,the amount of menstruation before surgery,the number of induced abortion and the degree of adhesions were closely related to the poor prognosis（P<0.05）.Multivariate Logistic regression analysis showed that the course of disease greater than12 months,preoperative amenorrhea,more than 3 times of induced abortion were all risk factors for poor prognosis after transcervical resection of adhesions.Conclusion1.Abnormal uterine junctional zone can affect endometrial recovery after surgery and reduce pregnancy rate in patients with intrauterine adhesions.2.The course of disease greater than 12 months,preoperative amenorrhea,more than 3 times of induced abortion are the risk factors for poor prognosis after transcervical resection of adhesions. |
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