| ObjectivesTo investigate the mechanism of prescription which nourish kidney and remove blood stasis in the prevention of the postoperative intrauterine re-adhesion. Based on the principle and methodology of EBM, a clinical trial,which was a randomized control research,was performed to clarify the effect and the safety of transcervical resection of adhesions combined with prescription which invigorate kidney and remove blood stasis.MethodsThe patients suffered moderate to severe degree uterine adhesion during jun 2014 to mar 2016 in Traditional Chinese Medicine Hospital of Guangdong Province.30 patients were randomly divided into two groups:treatment group (n=14) and control group (n=16). Patients in treatment group were treated with TCM and hormone artificial cycle after Adhesion separation under hysteroscopy surgery and super-ring. TCM was good at nourishing kidney and removing blood stasis. The patients in control group were only treated with hormone artificial cycle after surgery. The amenorrhoea suffered hysteroscopy surgery in follicular phase through basal body temperature. The patients for normal menstruation suffered hysteroscopy surgery after menstruation. The patients had given progynova by oral for 21 days in the second day after surgery, dydrogesterone in the last seven days. The next hormone artificial cycle would be carried out in the fifth day for menstrual cycle, but in the seventh day after drug withdrawa for non-menstruation. After three months treatment the patients were back to hospital by hysteroscopy examination and take-off the ring. The intrauterine adhesions degree score is according to the hysteroscopy reference scoring system by the American society of reproductive. A little endometrium tissue was taken to pathological examination during surgery. TGF-β1 and Smad3 were detected before and after the treatment.The score of TGF-β1 and Smad3 was referred to the relevant evaluation standard. Using SPSS package for windows17.0 statistical analysis to test all data, measurement data with t test and count data by chi-square test.The correlation between groups is tested by Pearson correlation analysis.Results1. Menstrual improvement:The difference of both groups had statistical significance pre-therapy and post-treatment in period, the quantity, color and quality of menstruation. There is no difference in menstrual cycle for control group. Treatment group is much better than control group in improvement of menstrual quantity.2. TCM syndromes:There is difference in treatment group of distending pain in lower abdomen, soreness and weakness of waist and knees, dizziness and tinnitus, dim complexion, but there is no difference in insomnia and forgetfulness. There is difference in control group in insomnia and forgetfulness, thirst. invigorating kidney and removing blood can obviously improve the syndromes of distending pain in lower abdomen, soreness and weakness of waist and knees, dizziness and tinnitus, dim complexion3. Score of intrauterine adhesion:There is difference in intrauterine adhesion score, which decreased, for pre-therapy and post-treatment both of them. There is no difference between treatment and control group after therapy.4. Endometrial recovery:The endometrium is much thicker after treatment both in treatment and control group. There is no difference between treatment and control group after therapy.5. Expression of TGF-β1 and Smad3:The expression of TGF-β1 and Smad3 is lower than that before treatment. The difference is significant statistically. there is no difference in the expression of TGF-β1 between treatment and control group after therapy. however, the difference of Smad3 had statistical significance between treatment and control group after therapy. the mechanism of prescription which invigorate kidney and remove blood stasis in the prevention of the postoperative intrauterine re-adhesion may be restrain the Expression of TGF-β1 and Smad3 in endometrium, which can prevent adhesion again. There is no correlation between the Expression of TGF-β1 and Smad3ConclusionCombining TCM and hormone artificial cycle has certain effect for prevent intrauterine adhesions recurrence after surgery. The therapy can improve the menstruation, such as:the period, quantity, color and quality of menstruation, at the same time. The therapy can improve the TCM syndromes, such as, lower abdomen, soreness and weakness of waist and knees, dizziness and tinnitus, dim complexion. The mechanism in the prevention of the postoperative intrauterine re-adhesion may restrain the expression of TGF-β1 and Smad3 in endometrium, effectively block the extracellular matrix deposition and endometrial fibrosis development,so as to repair endometrial and prevent intrauterine adhesions again... |
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