[1]何　琪,赵　芳,陈丽刚,等.中重度宫腔粘连患者宫腔粘连分离术后羊膜植入联合雌激素及重组人生长激素预防再粘连疗效观察[J].新乡医学院学报,2021,38(9):846-850.[doi:10.7683/xxyxyxb.2021.09.010]
　HE Qi,ZHAO Fang,CHEN Ligang,et al.Effect of amniotic membrane implantation combined with estrogen and recombinant human growth hormone in preventing the recurrence of intrauterine adhesion of patients with moderate and severe intrauterine adhesions after transcervical resection[J].Journal of Xinxiang Medical University,2021,38(9):846-850.[doi:10.7683/xxyxyxb.2021.09.010]
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中重度宫腔粘连患者宫腔粘连分离术后羊膜植入联合雌激素及重组人生长激素预防再粘连疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年9
页码:
846-850
栏目:
临床研究
出版日期:
2021-09-05

文章信息/Info

Title:
Effect of amniotic membrane implantation combined with estrogen and recombinant human growth hormone in preventing the recurrence of intrauterine adhesion of patients with moderate and severe intrauterine adhesions after transcervical resection
作者:
何　琪; 赵　芳; 陈丽刚; 曹　丽; 李　菲; 古衡芳; 涂　皎
（遵义医科大学附属妇女儿童医院妇产科，贵州　遵义　563000）
Author(s):
HE Qi; ZHAO Fang; CHEN Ligang; CAO Li; LI Fei; GU Hengfang; TU Jiao
(Department of Obstetrics and Gynecology,the Affiliated Maternal and Children Hospital of Zunyi Medical University,Zunyi 563000,Guizhou Province,China)
关键词:
宫腔粘连; 羊膜; 雌激素; 重组人生长激素; 宫腔粘连分离术
Keywords:
intrauterine adhesionsamniotic membraneestrogenrecombinant human growth hormonetranscervical resection of adhesions
分类号:
R737.3
DOI:
10.7683/xxyxyxb.2021.09.010
文献标志码:
A
摘要:
目的　探讨中重度宫腔粘连患者行宫腔粘连分离术(TCRA)后羊膜植入联合雌激素及重组人生长激素的治疗效果，寻找预防TCRA后宫腔再粘连的有效方法。方法　选择2018年4月至2019年4月遵义医科大学附属妇女儿童医院收治的中重度宫腔粘连患者200例为研究对象，按随机数字表法分为观察组和对照组，每组100例。2组患者均行TCRA，并以羊膜植入防止再粘连；同时，对照组患者给予口服戊酸雌二醇治疗，观察组患者给予口服戊酸雌二醇联合皮下注射重组人生长激素治疗,共2周。治疗前及术后第3个月经周期第10～15天,行超声检查观察子宫内膜厚度；术后3个月月经未恢复者行宫腔镜检查了解宫腔恢复情况，对再粘连患者再次行TCRA；术后3个月，观察2组患者子宫内膜改善情况；术前及术后3个月，采用美国生育学会(AFS)评分标准评估宫腔粘连范围、粘连性质、月经类型，并计算评价总分；术前及术后2周，采用酶联免疫吸附测定法检测2组患者血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、转化生长因子-β（TGF-β）、血管内皮生长因子（VEGF）水平。术后随访1 a，观察2组患者的临床治疗效果和妊娠率。结果　2组患者术前子宫内膜厚度比较差异无统计学意义（P>0.05）；2组患者治疗后子宫内膜厚度均较术前显著增加（P<0.05），观察组患者治疗后子宫内膜厚度及内膜增厚值均显著大于对照组（P<0.05）。术后3个月，对照组患者发生宫腔再粘连38例（38.0%），观察组患者发生宫腔再粘连18例（18.0%），观察组患者术后宫腔再粘连发生率显著低于对照组（χ2=9.921，P<0.05）。 术后3个月，对照组患者月经改善70例（70.0%）"，观察组患者月经改善96例（96.0%），观察组患者月经改善率显著高于对照组（χ2=23.955,P<0.05）。2组患者术前宫腔粘连范围、粘连性质、月经类型AFS评分及总分比较差异无统计学意义（P>0.05）；术后3个月，2组患者的宫腔粘连范围、粘连性质、月经类型AFS评分及总分均显著低于术前（P<0.05），观察组患者的宫腔粘连范围、粘连性质、月经类型AFS评分及总分均显著低于对照组（P<0.05）。2组患者术前血清IL-6、TNF-α、TGF-β、VEGF水平比较差异无统计学意义（P>0.05）；术后2周，2组患者血清IL-6、TNF-α、TGF-β、VEGF水平均显著低于术前（P<0.05），观察组患者血清IL-6、TNF-α、TGF-β、VEGF水平均显著低于对照组（P<0.05）。术后 1 a，对照组患者治愈42例，显效46例，无效12例，有效率88.0%（88/100），妊娠率12.0%（12/100）；观察组患者治愈64例，显效34例，无效2例，有效率 98.0%（98/100），妊娠率34.0%（34/100）；观察组患者的有效率和妊娠率均显著高于对照组（χ2=7.680、13.665,P<0.05）。结论　TCRA后使用羊膜植入联合雌激素和重组人生长激素治疗能更有效地改善中重度宫腔粘连患者TCRA后再粘连的发生和月经情况，提高其临床治疗有效率和妊娠率，具有更好的临床治疗效果。
Abstract:
Objective　To investigate the effect of amniotic membrane combined with estrogen and recombinant human growth hormone in preventing the recurrence of intrauterine adhesion of patients with moderate and severe intrauterine adhesions after transcervical resection of adhesions (TCRA).Methods　A total of 200 patients with moderate and severe intrauterine adhesions in the Affiliated Maternal and Children Hospital of Zunyi Medical University from April 2018 to April 2019 were selected as the research subjects,and they were randomly divided into observation group and control group,with 100 cases in each group.All patients underwent TCRA and then were given amniotic membrane implantation to prevent re-adhesion.Based on this,the patients in the observation group were treated with estrogen and human growth hormone,while the patients in the control group were only treated with estrogen.The thickness of endometrium of all patients was observed by ultrasonography before treatment and on the 10th-15th day of the third menstrual cycle after operation.The patients whose menstruation did not recover at three months after operation underwent hysteroscopy to observe the recovery of uterine cavity,and the patients with re-adhesion underwent TCRA again.The improvement of endometrium of patients in the two groups was observed at three months after operation.The range,nature and menstrual type of intrauterine adhesion were evaluated by using American Fertility Society (AFS) score and the total score was calculated before operation and three months after operation.The levels of serum interleukin-6 (IL-6),tumor necrosis factor-α(TNF-α),transforming growth factor-β（TGF-β）and vascular endothelial growth factor (VEGF) were measured by enzyme linked immunosorbent assay before and two weeks after operation.All patients were followed up for 1 year to observe the clinical treatment effect and pregnancy rate.Results　There was no significant difference in endometrial thickness of patients between the two groups before operation(P>0.05)the endometrial thickness of patients after treatment was significantly higher than that before operation in the two groups (P<0.05)the endometrial thickness and the increase of endometrial thickness of patients after treatment in the observation group were significantly higher than those in the control group (P<0.05).The incidence of intrauterine adhesion of patients in the control group and the observation group was 38.0%(38/100),18.0%(18/100),respectively at three months after operationthe incidence of intrauterine adhesion of patients in the observation group was significantly lower than that in the control group (χ2=9.921,P<0.05).The menstrual improvement rate of patients in the control group and the observation group was 70.0%(70/100),96.0%(96/100),respectively at three months after operationthe menstrual improvement rate of patients in the observation group was significantly higher than that in the control group (χ2=23.955,P<0.05).There was no significant difference in intrauterine adhesion range,adhesion nature,menstrual type,AFS score and overall score of patients between the two groups before operation(P>0.05).Three months after operation,the range,nature,menstrual type,AFS score and overall score of intrauterine adhesion of patients in the two groups were significantly lower than those before operation (P<0.05)the range,nature,menstrual type,AFS score and overall score of intrauterine adhesion of patients in the observation group were significantly lower than those in the control group (P<0.05).There was no significant difference in the serum levels of IL-6,TNF-α,TGF- β,VEGF of patients between the two groups before operation (P>0.05).Two weeks after operation,the serum levels of IL-6,TNF-α,TGF- β,VEGF of patients in the two groups were significantly lower than those before operation (P<0.05)and the serum levels of IL-6,TNF-α,TGF-β,VEGF of patients in the observation group were significantly lower than those in the control group (P<0.05).One year after operation,in the control group,42 cases were cured,46 cases were markedly effective,12 cases were ineffective,and the effective rate was 88.0% (88/100)in the observation group,64 cases were cured,34 cases were markedly effective,2 cases were ineffective,and the effective rate was 98.0% (98/100).The pregnancy rate of patients in the control group and the observation group was 12.0% (12/100),34.0% (34/100),respectively.The effective rate and pregnancy rate of patients in the observation group were significantly higher than those in the control group (χ2=7.680,13.665P<0.05).Conclusion　Amniotic placement combined with estrogen and human growth hormone after TCRA can effectively improve the occurrence of re-adhesion and menstruation of patients with moderate and severe intrauterine adhesion after TCRA,improve their clinical effective rate and pregnancy rate,and have better clinical therapeutic effect.

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更新日期/Last Update: 2021-10-09