| Objective:To analyze retrospectively the clinical data of 154 patients with moderate and severe intrauterinal adhesion(IUA)diagnosed and treated in Shenyang Maternal And Infant Hospital from January 2017 to February 2019 based on the patient case data,All patients were divided into study group and control group according to whether balloon dilatation was performed again one week after surgery.At the same time,the two groups of patients were further divided into two subgroups according to the different dosage of estrogen after operation.The changes of postoperative menstrual recovery,uterine cavity recovery and endometrium thickness in each group were compared respectively,Objective to investigate the clinical effect of secondary balloon dilation combined with different doses of estrogen in prevention of the readhesion after transcervical resection of adhesion(TCRA),so as to provide a reference for clinical treatment of IUA.Methods:Patients with moderate and severe IUA diagnosed and treated in our hospital from January 2017 to February 2019 were selected according to certain inclusion criteria.The study group included 84 patients who underwent secondary balloon dilatation 2 weeks after TCRA,and the control group included 70 patients who did not undergo secondary balloon dilatation 2 weeks after TCRA.At the same time,the study group was divided into two subgroups according to the different doses of estrogen used after TCRA: study group 1(oral estrogen 2mg/d after TCRA)and study group 2(oral estrogen 4mg/d after TCRA).The control group was also divided into two subgroups: control group 1(oral estrogen 2mg/d after TCRA)and control group 2(oral estrogen 4mg/d after TCRA).Changes in postoperative uterine cavity recovery,menstrual recovery and endometrial thickness were compared between the the study group and the control group as well as between each subgroup.Statistical analysis was performed using SPSS 24.0 statistical software.The measurement data conform to the normal distribution,and the mean±standard deviation((?)±s)was expressed.The comparison between groups was performed by independent sample t test.The chi-square test was used for the counting data.If the expected frequency of any grid is less than 1 or the total number of cases is less than 40,the Fisher’s exact probability test was used,Using rank sum test to analyse ranked data.The P<0.05 was considered statistically significant.The P>0.05 was not statistically significant.Results:1.secondary balloon dilation group was compared with single balloon dilation group1.1 Study group was compared with control group There was no significant difference in general information between the study group and the control group(including The degree of intrauterine adhesion[According to the European Society of Gynaecological Endoscopy diagnostic criteria for intrauterine adhesions],preoperative endometrial thickness,estrogen dosage and duration of disease,etc.)(P > 0.05).All 154 patients were successfully operated.Comparison of the two groups after transcervical resection of adhesion:(1)Uterine cavity recovery(The ESGE Grade):After TCRA,the uterine cavity of the study group returned to normal,mild(ⅠorⅡdegrees),moderate(Ⅲ degrees)and severe(Ⅳ degrees and above)were respectively: 46 cases(54.8%),30cases(35.7%),8cases(9.5%),and 0 cases;The control group were respectively: 22 cases(31.4%),35cases(50.0%),13 cases(18.6%)and 0 cases,P=0.003,the difference between the two group was considered statistically significant.(2)Menstrual recovery: After TCRA,the effective cases(cured cases + improved cases)and ineffective cases of menstrual recovery in the study group were respectively :79 cases(94.0%)and 5 cases(6.0%),while the control group were respectively: 54cases(77.1%)and 16 cases(22.9%),P=0.002,the difference between the two group was considered statistically significant.(3)The endometrial thickness:The endometrial thickness after TCRA in the study group was(6.27±1.29)mm,and that in the control group was(5.88±1.24)mm,P=0.056,with no significant difference between the two groups.(4)pregnancy: In the follow-up 12 months after TCRA,32 cases(38.1%)of total pregnancy in the study group,compared with 20 cases(28.6%)of total pregnancy in the control group,P=0.213,with no significant difference between the two groups.1.2 study 1 group was compared with control 1 group There was no significant difference in general data between study 1 group and control 1 group(P >0.05).After TCRA,the efficacy of the two groups of patients was compared:(1)Uterine cavity recovery(The ESGE Grade):After TCRA,the uterine cavity of the study 1 group returned to normal,mild(ⅠorⅡdegrees),moderate(Ⅲ degrees)and severe(Ⅳ degrees and above)were respectively: 17 cases(73.9%),4 cases(17.4%),2cases(8.7%),and 0 cases;The control 1 group were respectively: 11 cases(39.3%),14cases(50.0%),3 cases(10.7%)and 0 cases,P=0.027,the difference between the two group was considered statistically significant.(2)Menstrual recovery: After TCRA,the effective cases(cured cases + improved cases)and ineffective cases of menstrual recovery in the study 1 group were respectively : 23 cases(100%)and 0 cases,while the control 1 group were respectively:22 cases(78.6%)and 6 cases(21.4%),P=0.027,the difference between the two group was considered statistically significant.(3)The endometrial thickness:The endometrial thickness after TCRA in the study1 group was(6.22±1.24)mm,and that in the control 1 group was(5.82±1.19)mm,P=0.251,with no significant difference between the two groups.1.3 study 2 group was compared with control 2 group There was no significant difference in general data between study 2 group and control 2 group(P >0.05).After TCRA,the efficacy of the two groups of patients was compared:(1)Uterine cavity recovery(The ESGE Grade):After TCRA,the uterine cavity of the study 2 group returned to normal,mild(ⅠorⅡdegrees),moderate(Ⅲ degrees)and severe(Ⅳ degrees and above)were respectively: 29 cases(47.5%),26 cases(42.6%),6cases(9.9%),and 0 cases;The control 2 group were respectively: 11 cases(26.2%),21cases(50.0%),10 cases(23.8%)and 0 cases,P=0.013,the difference between the two group was considered statistically significant.(2)Menstrual recovery: After TCRA,the effective cases(cured cases + improved cases)and ineffective cases of menstrual recovery in the study 2 group were respectively : 56 cases(91.8%)and 5 cases(8.2%),while the control 2 group were respectively: 32 cases(76.2%)and 10 cases(23.8%),P=0.027,the difference between the two group was considered statistically significant.(3)The endometrial thickness:The endometrial thickness after TCRA in the study2 group was(6.30±1.32)mm,and that in the control 2 group was(5.92±1.29)mm,P=0.152,with no significant difference between the two groups.2.Comparison of different estrogen dosage2.1 Study 1 group was compared with study 2 group There was no significant difference in general data between study 1 group and study 2 group(P >0.05).After TCRA,The efficacy of the two groups was compared:(1)Uterine cavity recovery(The ESGE Grade):After TCRA,the uterine cavity of the study 1 group returned to normal,mild(Ⅰor Ⅱdegrees),moderate(Ⅲ degrees)and severe(Ⅳ degrees and above)were respectively: 17 cases(73.9%),4 cases(17.4%),2case(8.7%),and 0 cases;The study 2 group were respectively: 29 cases(47.5%),26cases(42.6%),6 cases(9.9%)and 0 cases,P=0.054,with no significant difference between the two groups.(2)Menstrual recovery: After TCRA,the effective cases(cured cases + improved cases)and ineffective cases of menstrual recovery in study 1 group were respectively :23 cases(100%)and 0 cases,The study 2 group were respectively:56 cases(91.8%)and 5 cases(8.2%),P=0.316,with no significant difference between the two groups.(3)Endometrial thickness: After TCRA,Theendometrial thickness of the study 1group was(6.22±1.24)mm,and that of the study 2 groups was(6.30±1.32)mm,P=0.808,with no significant difference between the two groups.2.2 Control 1 group was compared with control 2 group There was no significant difference in general data between control 1 group and control 2 group(P >0.05).After TCRA,the efficacy of the two groups of patients was compared:(1)Uterine cavity recovery(The ESGE Grade): After TCRA,the uterine cavity of the control 1 group returned to normal,mild(Ⅰor Ⅱdegrees),moderate(Ⅲ degrees)and severe(Ⅳ degrees and above)were respectively : 11 cases(39.3%),14 cases(50.0%),3 cases(10.7%),and 0 cases;The control 2 group were respectively: 11 cases(26.2%),21 cases(50.0%),10 cases(23.8%)and 0 cases,P=0.130,with no significant difference between the two groups.(2)Menstrual recovery: After TCRA,the effective cases(cured cases + improved cases)and ineffective cases of menstrual recovery in control 1 group were respectively :22 cases(78.6%)and 6 cases(21.4%),while in control 2 group were respectively:32cases(76.2%)and 10 cases(23.8%),P=0.816,with no significant difference between the two groups.(3)Endometrial thickness: After TCRA,The endometrial thickness of the control1 group was(5.82±1.19)mm,and that of the control 2 groups was(5.92±1.29)mm,P=0.756,with no significant difference between the two groups.Conclusion:1.After TCRA,secondary balloon dilation is more conducive to promoting the recovery of uterine cavity and improving the menstrual condition of patients.It is worthy of clinical implementation,because of the advantages of simple operation,low cost,no need for special equipment and anesthesia,can be implemented in the outpatient department,and easy to be accepted by patients.2.After TCRA,the application of estrogen can promote endometrial regeneration.Our study found that increasing the dosage of estrogen after surgery could not improve the surgical effect.However,whether further increase of estrogen dose is beneficial to postoperative recovery still needs to be confirmed by high-quality,Prospective cohort studies,so as to obtain the optimal estrogen dose to prevent readhesion after TCRA. |
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