| Objective:Intrauterine adhesion(IUA)is caused by partial or complete adhesion of uterus or cervical canal when fibrotic tissue repairs after endometrial basal layer suffers injury,resulting in reduced menstrual volume and even amenorrhea,infertility,etc,seriously endangering women’s health.Transcervical resection of adhesion(TCRA)is the most ideal surgical method,but the recurrence rate of severe IUA after surgery is as high as 20%～62.5%.In 2015,the consensus of Chinese experts on the clinical diagnosis and treatment of intrauterine adhesions suggested that estrogen should be used after TCRA,with or without progesterone as adjuvant therapy.However,opinions on the therapeutic dose,administration mode of estrogen and adding progesterone are not completely unified,and relevant comparative studies are few and all of them are small sample data.Therefore,it is significant to explore the effect of different estrogen treatment after TCRA.The purpose of this study is to explore the clinical therapeutic effect of estrogen therapy with different administration methods after TCRA of moderate and severe intrauterine adhesions,and to provide reference for clinical treatment.Methods:A total of 136 patients diagnosed with moderate and severe intrauterine adhesions in the First Affiliated Hospital of Zhengzhou University from September 2018 to November 2020 were retrospectively analyzed.According to different postoperative estrogen administration methods,they were divided into the percutaneous estrogen group(n=42),the oral estrogen group(n=44),and the oral estrogen and progesterone group(n=50).Estrogen was applied to all patients on the 1st day after hysteroscopic surgery.The transdermal estrogen group was received external application of transdermal estradiol gel(2.5g,bid),the oral estrogen group was received estradiol valerate tablets(3mg,qd),and the oral estrogen and progesterone group was received estradiol tablets/estradiol and dydrogesterone compound tablets(2mg:10mg,qd)besides estradiol valerate tablets(1mg,qd).All patients were received hysteroscopic separation of intrauterine adhesions in our hospital,and intrauterine injection of hyaluronic acid was completed after the operation,and the intrauterine catheter balloon was placed for 5 days postoperatively,followed by antibiotic treatment for 3 days.After 2 months of estrogen treatment,they returned to hospital for hysteroscopy after menstruation was clean.Menstrual improvement,uterine morphology improvement,AFS intrauterine adhesion classification score and endometrial thickness changes in the middle proliferative period(day 8 to 10 of the menstrual cycle)were compared in the three groups after 2 months.Results:1.The menstrual of the three groups was significantly improved after treatment.The menstrual improvement rate of the percutaneous estrogen group was 90.48%,the menstrual improvement rate of the oral estrogen group was 86.36%,and the menstrual improvement rate of the oral estrogen and progesterone group was 96.00%,but there was no statistical significance between the three groups(P>0.05).2.After treatment,the uterine cavity morphology of patients in the three groups was significantly improved.The improvement rate of uterine cavity morphology in the percutaneous estrogen group was 88.09%,that of the oral estrogen group was 90.91%,and that of the oral estrogen and progesterone group was 94.00%,but there was no statistical significance between the three groups(P>0.05).3.The AFS scores of intrauterine adhesions in the three groups showed statistically significant differences after treatment compared with before(P<0.05),and the AFS scores decreased significantly after treatment.There was statistical significance in AFS scores among the three groups after treatment(P<0.05).The pairwise comparison showed statistically significant differences(P<0.05).After treatment,the AFS score of the oral estrogen and progesterone group was lower than the percutaneous estrogen group who was lower than the oral estrogen group.4.The endometrium thickness of the three groups in the middle proliferative period after treatment showed statistically significant difference compared with that before(P<0.05),and the endometrium thickness increased significantly after treatment.There was statistical significance in endometrial thickness among the three groups after treatment(P<0.05).There was no statistically significant difference between the transdermal estrogen group and the oral estrogen group(P>0.05).The oral estrogen and progesterone group was compared with the transdermal estrogen group and the oral estrogen group,and the differences were statistically significant(P<0.05).The endometrial thickness of the oral estrogen and progesterone group increased significantly in the middle proliferative period.5.The incidence rate of adverse effects was 0.00%in the percutaneous estrogen group,9.09%in the oral estrogen group,10%in the oral estrogen and progesterone group.There was no statistical significance in the incidence of adverse reactions among 3 groups(P>0.05).Conclusion:1.Hysteroscopic separation of intrauterine adhesions combined with hyaluronic acid,balloon catheter and estradiol in the treatment of intrauterine adhesions has a definite effect on improving menstruation and uterine cavity morphology,reducing AFS score and increasing endometrial thickness during middle proliferative period.2.The effect of estradiol gel in the treatment of intrauterine adhesions is similar to that of estradiol valerate,with better effect in reducing AFS score.It is convenient for transdermal administration and worthy of promotion.3.Compared with estradiol valerate alone,the addition of progesterone in the second half of the menstrual cycle in the treatment of intrauterine adhesions can significantly reduce the AFS score and increase the endometrial thickness in the middle proliferative period. |
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