| Objective: Intrauterine adhesion(IUA),also known as Asherman syndrome,is generally considered to be endometrial injury caused by intrauterine operation or endometrial infection that damages the basal layer of the endometrium.Inability to regenerate and repair,scarring of the fibers at the endometrial injury,reduced menstrual flow or even amenorrhea,deforms the uterine cavity,abnormal shape,and affects fertility.The increase in hysteroscopic surgery and artificial abortion has caused the endometrial injury to increase,and the incidence of IUA has also increased year by year.Hysteroscopic transcervical resection of adhesions(TCRA)is the preferred surgical method for the treatment of IUA.The operation under direct vision reduces the secondary damage caused by blind operation.The recurrence rate of adhesions after surgical treatment is higher and the highest up to 62.5%.Clinically,combined treatment is mainly used to prevent postoperative re-adhesion.Use the intrauterine barrier method to isolate the wound in the uterine cavity to prevent adhesion of the adhering surface,such as uterine balloon,sodium hyaluronate or intrauterine device.After TCRA,supplement drugs that promote endometrial growth and repair,such as estrogen,progesterone,and growth hormone.Compared with single estrogen and progesterone therapy,combined therapy has a certain effect,but it is not satisfactory,and the probability of re-adhesion after surgery is still higher.Aspirin can inhibit cyclooxygenase activity and inhibit the synthesis of prostacyclin and thromboxane A2.The addition of aspirin after TCRA can be used to inhibit platelet adhesion and anti-platelet aggregation,promote endometrial repair and increase the blood supply of the endometrium.This study is to investigate the use of aspirin in comprehensive treatment after TCRA to observe whether it can increase the thickness of the endometrium,restore menstrual flow,improve fertility,and reduce the recurrence rate of re-adhesion.Methods: From January 2017 to January 2019,67 patients with moderate to severe IUA diagnosed by hysteroscopy in our hospital were selected.The clinical symptoms were reduced menstrual flow,amenorrhea,and infertility.All patients underwent TCRA and were divided into two groups according to the different treatment measures given after the operation: 31 cases in the study group,combined use of Foly balloon + estrogen and progesterone + growth hormone after hysteroscopic hysterectomy aspirin.In the control group,36 patients only used Foly balloon + estrogen and progesterone + growth hormone after TCRA.The IUA classification was based on the classification of intrauterine adhesions of the Chinese Medical Association in 2015,and moderate to severe intrauterine adhesions were selected as the research object.After TCRA and 3 months after comprehensive treatment,follow up the endometrial thickness of the two groups of patients,compare the shape of the uterine cavity of the two groups,record and compare the type A endometrial type ratio and menstrual recovery of the two groups after treatment,and follow up Recovery of menstruation and pregnancy after 1 year.Record and analyze data to evaluate its clinical effectiveness.Results: Three months after operation,the endometrial thickness and endometrial type of group A in the study group were higher than those in the control group(P<0.05);the effective rate of uterine cavity restoration and menstrual recovery in the study group were higher than those in the control group,but they were not statistically significant(P>0.05).The menstrual recovery rate in the study group was higher than that in the control group one year after operation(P<0.05),and the pregnancy status was not statistically significant compared with the control group(P>0.05).Conclusion: The combined use of aspirin in the comprehensive treatment of moderate to severe intrauterine adhesions can effectively promote the recovery of the endometrium,increase the thickness of the endometrium and the proportion of type A endometrial,and improve the recovery of menstruation,but it has no effect on the pregnancy rate. |
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