摘要
目的:探讨宫腔镜宫腔粘连分离术(TCRA)后子宫内膜对不同剂量雌激素的反应与生殖预后改善之间的关系。方法:选择2016年1月至2020年1月就诊于宁夏医科大学总医院妇科宫腔镜中心确诊并接受以TCRA手术为主的综合治疗的中、重度宫腔粘连(IUA)患者163例为研究对象,其中,IUA中度114例,IUA重度49例;每组内术后区组随机化分组法分为雌激素(戊酸雌二醇)大剂量组(8 mg/d,中度57例,重度24例)、中剂量组(4 mg/d,中度57例,重度25例),用药2月后复查宫腔镜对比分析子宫内膜修复和再粘连情况;将宫腔形态基本恢复的可备孕患者改行小剂量雌激素(1 mg/d)人工周期维持至孕3月,B超监测排卵期子宫内膜厚度,对比分析备孕1年内的生殖情况。结果:(1)术后2个月IUA中度及重度患者宫腔镜复查,IUA中度患者的大剂量组与中剂量组在正常/基本正常宫腔率、内膜上皮化满意率、内膜腺管密度满意率及再粘连率间比较,差异均无统计学意义(P>0.05);IUA重度患者的大剂量组的内膜上皮化满意率、内膜腺管密度满意率优于中剂量组,差异有统计学意义(P<0.05)。(2)宫腔形态恢复正常的143例患者采用小剂量雌激素(1 mg/d)进入备孕阶段,IUA中度及重度患者的大剂量组与中剂量组间有反应型的比例差异无统计学意义(P>0.05)。(3)143例患者中,子宫内膜对小剂量雌激素有反应型85例,78例获孕;低反应型58例,10例获孕。子宫内膜有反应型的患者自然受孕率、辅助生殖受孕率、足月产率均高于低反应型,差异有统计学意义(P<0.05)。结论:TCRA术后大剂量雌激素对IUA重度患者子宫内膜的修复更有效,TCRA术后远期小剂量雌激素的运用在大剂量组及中剂量组间差异不明显,但对远期小剂量雌激素有反应的子宫内膜可能意味着更好的功能性修复,可能是影响生殖预后的重要因素。
Objective:To analyze the relationship between endometrial response to different doses of estrogen and improvement of reproductive prognosis after hysteroscopic intrauterine adhesion separation(TCRA).Methods:A total of 163 patients with moderate and severe intrauterine adhesion(IUA)who were diagnosed in gynecological Hysteroscopy Center of Ningxia Medical University General Hospital from January 2016 to January 2020 and received comprehensive treatment based on TCRA surgery were selected as the study subjects,including114 patients in the moderate IUA group and 49 patients in the severe IUA group.Each group was randomly divided into two subgroups:estrogen high-dose group(8 mg/d,57 cases of moderate and 24 cases of severe)and estrogen medium-dose group(4 mg/d,57 cases of moderate and 25 cases of severe).Endometrial repair and readhesion were analyzed by hysteroscopy 2 months after medication.The patients with basically recovered uterinecavity morphology would take estrogen(1 mg/d)periodically until the third month of pregnancy.B-ultrasound was used to measure the endometrial thickness during ovulation,and the reproductive outcomes within one year of pregnancy preparation were compared and analyzed.Results:(1)Two months after operation,the hysteroscopic reexamination of moderate and severe IUA patients showed that there were no statistically differences on the aspects of“normal/basically normal uterine cavity rate”,“satisfaction rate of cavity epithelialization”,“satisfaction rate of endometrial glandular density”and“readhesion rate”between the two subgroup of moderate IUA patients.In the severe IUA group,the high-dose estrogen subgroup was superior to the medium-dose IUA subgroup in“satisfaction rate of endometrial epithelialization”and“satisfaction rate of endometrial gland density”with statistical difference(P<0.05).(2)In 143 patients with normal uterine cavity,small dose of estrogen(1 mg/d)was used to get into the stage of pregnancy preparation,and there was no statistical difference in the proportion of reactive type between the two groups and subgroups(P>0.05).(3)Among 143 patients,endometrium of 85 cases were well-responded to low dose estrogen,in which 78 cases got pregnant;endometrium of 58 cases were poor-responded to low dose estrogen,in which 10 cases got pregnant.The natural pregnancy rate,assisted reproductive pregnancy rate and full term birth rate of patients which were well-responded to low dose estrogen were superior to those with poor-respond,and the difference was statistically significant(P<0.05).Conclusions:Highdose estrogen is more effective in repairing endometrium after TCRA.There was no significant difference between the subgroups in the long-term low-dose estrogen application,however the endometrial that well-responded to low dose estrogen may get better functional regeneration and may be an important reproductive prognostic factor.
作者
张慧星
徐大宝
胡明月
元娟娟
赵世云
曹佳
刘丹
ZHANG Huixing;XU Dabao;HU Mingyue(College of Clinical Medicine,Ningxia Medical University,Yinchuan Ningxia 750004,China;Department of Obstetrics and Gynecology,The Third Xiangya Hospital,Central South University,Changsha Hunan 410013,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2022年第1期48-52,共5页
Journal of Practical Obstetrics and Gynecology
基金
国家自然科学基金(编号:81860264)
宁夏自治区重点研发项目(编号:2020BFG02018)
宁夏医科大学总医院临床医学研究中心2020开放课题(编号:2020410)。
关键词
经宫腔镜宫腔粘连分离术
雌激素
宫腔粘连
子宫内膜修复
生殖预后
Hysteroscopic intrauterine adhesion separation
Estrogen
Intrauterine adhesion
Endometrial repair
Reproductive prognosis
