Analysis Of High Risk Factors And Formation Mechanism Of Previous Cesarean Scar Defect With Endometrial Polyps

Objective To investigate the high-risk factors and the formation mechanism of uterine scar diverticulum combined with endometrial polyp,then prevent the occurrence of the disease,and at the same time,to provide a theoretical basis for the treatment of patients with uterine scar diverticulum combined with endometrial polyp in the later stage.Methods A total of 402 patients who underwent hysteroscopy and segmental curettage with definitive diagnosis from June 2018 to January 2020 in the First Affiliated Hospital of Anhui Medical University were selected.They were divided into four groups according to the hysteroscopic findings: experimental group(group A):uterine scar diverticulum combined with endometrial polyps,80 individuals;control group 1(group B): uterine scar diverticulum,103 individuals;control group 2(Group C): endometrial polyps,110 individuals;control group 3(Group D): normal uterine cavity,109 individuals.The information related to cesarean delivery of patients was counted by questionnaire,clinical risk factors were identified by analysis and comparison,and ER,PR,TNF-α,IL-6 expression in the intimal tissue of patients after curettage were analyzed by immunohistochemistry.Results 1.Uterine scar diverticulum combined with high-risk factors for endometrial polyps: proportion of women of advanced maternal age,gestational age,proportion undergoing tubal ligation,proportion undergoing emergency surgery,proportion with meconium contamination of amniotic fluid,proportion with premature rupture of membranes,proportion with vaginal examination,proportion with posterior uterus,proportion undergoing transvaginal test,proportion undergoing multiple cesarean section,anaemia(Hb < 110 g / L),and proportion with comorbidities during pregnancy differed among the four groups The proportion of women of advanced maternal age,proportion undergoing emergency surgery,proportion with meconium contamination of amniotic fluid grade III,proportion with premature rupture of membranes,proportion undergoing vaginal examination,proportion with posterior uterus,proportion undergoing transvaginal test delivery,proportion undergoing multiple cesarean sections,proportion with anemia(Hb < 110 g / L),and proportion with comorbidities during pregnancy were all highest in group A(P < 0.05).Further comparative analysis between groups A and D suggested that advanced maternal age,multiple cesarean section,emergency cesarean section,premature rupture of membranes,vaginal examination,comorbidities during pregnancy,and posterior uterine location were independent risk factors for the development of uterine scar diverticulum combined with endometrial polyps(P < 0.05).2.Analysis of the immunohistochemical results,the mechanism of uterine scar diverticulum combined with endometrial polyp formation,(1)ER expression profile: group A had the largest OD value,and the highest positive rate and strong positive rate of Er,the difference was statistically significant(P < 0.05),(2)PR expression profile: group A had the smallest OD value,and the lowest positive rate of PR,the difference was statistically significant(P < 0.05),(3)TNF-α expression profile(4)IL-6 expression: group A has the largest OD value,and TNF-α has the highest positive rate and strong positive rate,with statistically significant differences(P < 0.05).Conclusion 1.Uterine scar diverticulum combined with endometrial polyp formation is associated with the cesarean section procedure and patients’ own factors,but also with the imbalance of the distribution of oestrogen progesterone receptors and the inflammatory stimulus.2.High expression in endometrial tissue in ER patients with uterine scar diverticulum combined with endometrial polyps,while PR was low.3.TNF-α、IL-6 was highly expressed in the endometrial tissue of patients with uterine scar diverticulum combined with endometrial polyps.