| Objective 1.To study the effect of uterine cavity irrigation on the prognosis of patients with moderate and severe intrauterine adhesions,and to explore a more effective method to prevent uterine re-adhesion.2.The related factors affecting pregnancy within 2 years after operation in patients with moderate and severe intrauterine adhesions were retrospectively analyzed,and a nomogram prediction model was established to provide theoretical basis for fertility guidance.Materials and Methods Part Ⅰ:A prospective study was conducted in the third affiliated Hospital of Zhengzhou University from January 2019 to December 2019.92 patients with moderate and severe intrauterine adhesions were willing to receive treatment and were followed up completely.the patients were randomly divided into two groups according to the time of admission.Group A(n = 46),including 30 cases of moderate adhesion and 16 cases of severe adhesion,were placed with three-lumen balloon catheter after operation.Normal saline was used for uterine irrigation and drainage immediately after operation and 48 hours after operation.There were 46 patients in group B,including 29 cases of moderate adhesion and 17 cases of severe adhesion.Two-lumen balloon catheter was placed after operation.Both groups of patients started artificial cycle therapy on the second day after operation,and took out the balloon on the 5th day after operation,placed sodium hyaluronate and metal ring.After 2 artificial cycles of treatment,hysteroscopy was performed in our hospital 3-7 days after menstruation.The volume of drainage and the incidence of adverse reactions in the two groups were observed,the changes of postoperative endometrial thickness,menstruation and hysteroscopy were recorded,and the pregnancy within one year after operation was followed up by telephone,and the related data were statistically analyzed.Part Ⅱ:The clinical data of 338 patients with moderate and severe intrauterine adhesions who underwent TCRA in the third affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively analyzed.The patients were divided into two groups(pregnancy group and non-pregnancy group)according to whether they were pregnant within 2 years after operation.The relevant clinical data of the patients were collected and recorded.Univariate and multivariate Logistic regression analysis were used to explore the factors affecting postoperative pregnancy in patients with moderate and severe intrauterine adhesions,and a nomogram model was established to predict postoperative pregnancy in patients with moderate and severe intrauterine adhesions.Results Part Ⅰ: 1.General data There was no significant difference in age、BMI、times of pregnancy、times of uterine surgery and degree of adhesion between the two groups(P > 0.05).2.Endometrial thickness After treatment,the endometrial thickness in group A and B were(6.00 ±1.56)mm and(5.35 ±1.13)mm,respectively,and the difference was statistically significant(P < 0.05).For the patients with moderate intrauterine adhesions,the endometrial thickness of group A was better than that of group B after treatment,and the difference was statistically significant(P < 0.05).However,for patients with severe intrauterine adhesions,there was no significant difference in endometrium between group A and group B after treatment(P > 0.05).3.Menstrual recovery The total effective rate of menstrual recovery in group A and B after treatment was 86.96% and 65.22% respectively,and the difference was statistically significant(P < 0.05).For patients with moderate intrauterine adhesions,the effective rate of menstrual recovery in group A was significantly higher than that in group B(P < 0.05).However,for the patients with severe intrauterine adhesions,there was no significant difference in the effective rate of menstrual recovery between group A and group B after treatment(P > 0.05).4.Uterine cavity recovery After hysteroscopy,the total effective rate of uterine cavity recovery in group A and B was 89.13% and 69.57% respectively,and the difference was statistically significant(P < 0.05).For patients with moderate intrauterine adhesions,the effective rate of uterine cavity recovery in group A was significantly higher than that in group B(P < 0.05).However,for the patients with severe intrauterine adhesions,there was no significant difference in the effective rate of uterine cavity recovery between group A and group B after treatment(P > 0.05).5.Total uterine drainage fluid volume and adverse reactions The total volume of uterine drainage in group A and B were(2.91±1.49)ml and(5.61±1.78)ml,respectively,and the difference was statistically significant(P < 0.05).There was no significant difference in adverse reactions between the two groups(P > 0.05).6.Pregnancy rate The patients were followed up for 1 year,19 patients in group A were pregnant,the pregnancy rate was 41.30%,14 patients in group B were pregnant,and the pregnancy rate was 30.43%.There was no significant difference between the two groups(P > 0.05).No matter for the patients with moderate or severe intrauterine adhesions,there was no significant difference in pregnancy rate between group A and group B(P > 0.05).Part Ⅱ: 1.In this study,338 patients with moderate and severe intrauterine adhesions were followed up successfully.154 cases became pregnant within 2 years after operation,with a pregnancy rate of 45.56%(154/338).2.Univariate and multivariate Logistic regression analysis of the preoperative,intraoperative and postoperative data of the two groups showed that age、degree of adhesion、postoperative endometrial thickness、menstrual recovery and uterine cavity recovery were independent influencing factors of pregnancy within 2 years after operation in patients with moderate and severe intrauterine adhesions.Based on the above factors,the predicted value in the calibration curve is basically consistent with the measured value,and the C-index is 0.860,indicating that the model has good accuracy and consistency.Conclusion Part Ⅰ: Uterine cavity irrigation after TCRA can effectively promote the endometrial recovery of patients with moderate intrauterine adhesions,help to reduce the rate of uterine re-adhesion,and better improve menstruation,but the clinical effect of severe intrauterine adhesions is not significantly improved.Part Ⅱ: The pregnancy rate of moderate and severe intrauterine adhesions after TCRA is still low.Age、degree of adhesion、postoperative endometrial thickness、menstrual recovery and uterine cavity recovery are the main factors affecting the patient’s pregnancy.The established nomogram model can be used as a reference to predict the pregnancy probability of patients with moderate and severe intrauterine adhesions within 2 years after operation,and help clinicians to adjust the treatment strategy properly. |
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