Analysis Of Prognostic Factors And Pregnancy In Patients With Moderate And Severe Intrauterine Adhesions

ObjectiveObjective To analyze the clinical efficacy and pregnancy of patients with moderate and severe intrauterine adhesions after surgical treatment in our hospital,and to explore the preoperative,intraoperative and postoperative factors affecting the surgical efficacy,so as to provide objective basis for individualized treatment.MethodsA total of 171 patients with moderate and severe intrauterine adhesions（according to the Chinese IUA classification standard）who were treated surgically in our hospital from January 2017 to September 2019 were selected as the research objects.Group according to adhesion degree:moderate group and severe group;According to the preoperative factors,intraoperative factors,and postoperative factors,each group was divided into groups.According to the pregnancy after operation,the patients were divided into two groups:pregnant group and non-pregnant group.To observe the clinical curative effect（menstruation recovery and uterine cavity morphology after operation）,pregnancy（confirmed by B-ultrasound within 1 year after operation）,general preoperative conditions,intraoperative conditions and postoperative conditions that affect the prognosis,and to explore the preoperative,intraoperative and postoperative influencing factors that affect the surgical curative effect.Results1.171 cases of postoperative clinical efficacy:171 cases of moderate and severe intrauterine adhesions had a clinical effective rate of 54.97%（93/171）,of which62.12%（82/132）were moderate adhesions and 28.21%（11/39）were severe adhesions.the clinical effective rate of moderate intrauterine adhesions was significantly higher than that of severe group（X²=13.959,p<0.05）.2.related factors affecting the clinical efficacy:（1）age factor:the clinical effective rate of the age group<35 years old is 58.41%,which is significantly higher than that of the age group>35 years old by 44.83%（X²=2.844,p>0.05）.（2）premenstrual menstruation:the clinical effective rates of the three groups were60.00%,61.68%and 33.33%respectively(X² _{normal-decrease-amenorrhea}=9.579,p<0.05,X²_{decrease-amenorrhea}=9.251,p<0.0125).（3）onset time before treatment:the effective rate of 65%in patients with course≤12 months is significantly higher than that of 46.15%in patients with course>12 months（X²=6.109,p<0.05）.（4）preoperative drug use:the effective rate of preoperative estrogen use is 45.65%lower than 57.60%of patients without estrogen（X²=1.935,p>0.05）.（5）number of induced abortions before operation:the clinical effective rates of patients with 0 induced abortions,1-3 induced abortions and>3 induced abortions were27.27%,63.97%and 36.36%respectively(X²=13.159,p<0.05,X² _{1 to 3 times->3 times}=9.753,p<0.0125).（6）uterine cavity adhesion site:the clinical effective rates of the four groups of adhesion patients with lower uterine segment adhesion,upper uterine segment adhesion,unilateral uterine horn adhesion and bilateral uterine horn adhesion are 65.00%,63.83%,59.57%and 38.60%respectively（X²=8.836,p<0.05,the p values of the two groups are both>0.0071）.（7）intraoperative electrotomy:the effective rate after hysteroscopic electrotomy is 50.00%,which is higher than 45.45%in cold knife group(X² _{moderate-severe}=11.10,p<0.05,X² _moderate=0.010,p>0.05,X² _severe=0.000,p>0.05).（8）operation time:the clinical effective rate of≤30min is 61.76%,which is higher than that of>30 min（49.51%）（X²=2.478,p>0.05）.（9）comparison of hormone treatment dose difference after operation:the clinical effective rates of the three groups of patients who took orally estradiol valerate tablets≤4mg,6mg and≥8mg after operation were 53.23%,64.71%and 39.02%respectively(X²_{≤4 mg-=6 mg-≥8 mg}=6.974,p<0.05,X²_=6mg-≥8mg=6.871,p<0.0125).（10）postoperative adjuvant therapy:the clinical effective rates of IUD,balloon,balloon+amniotic membrane,balloon+sodium hyaluronate,IUD+sodium hyaluronate were 40%,53.33%,46.67%,60%,59.38%（X²=4.042,p>0.05）,respectively.Multivariate analysis showed that preoperative adhesion was an independent risk factor affecting clinical efficacy（P<0.05,OR:4.455,CI:2.037-9.741）.3.Pregnancy situation in one year after operation:the evaluation age is less than or equal to 45 years old,105 cases are planned to be pregnant,32 cases are pregnant,73 cases are not pregnant,the overall pregnancy rate is 30.48%;There were 72 patients with moderate adhesion,the pregnancy rate was 34.72%（25/72）,and the pregnancy rate of 33 patients in severe group was 15.15%（5/33）,which was higher in moderate group than in severe group（X²=4.247,p<0.05）.Pregnancy outcome of pregnant patients:4 cases of moderate embryo abortion,3 cases of pregnancy after IVF,33 cases of severe adhesion,including 1spontaneous abortion and 2 cases of pregnancy after IVF.ConclusionThe clinical efficacy of patients with moderate intrauterine adhesion is better than that of severe group;2.The amount of menstrual period before surgery,the number of induced abortions,the position of intrauterine adhesion,the dose of auxiliary estrogen after surgery are closely related to the clinical efficacy,and before surgery The degree of adhesion is an independent risk factor that affects clinical efficacy;postoperative clinical efficacy of 6mg estrogen is higher;3.The pregnancy rate of patients with moderate to severe adhesions after TCRA is lower than the effective rate of clinical treatment.