Hu Yulin, Ma Ying, Li Wenjuan, Qu Jinglan
Department of Women's Health, Baoji Maternal and Child Health Hospital No. 2, East Section of Xinjian Road, Weibin District, Baoji 721000, Shaanxi, China.
Department of Obstetrical, Baoji Maternal and Child Health Hospital No. 2, East Section of Xinjian Road, Weibin District, Baoji 721000, Shaanxi, China.
Am J Transl Res. 2024 Oct 15;16(10):5605-5613. doi: 10.62347/GRAK9062. eCollection 2024.
To investigate the long-term effects of hysteroscopic adhesiolysis on postoperative pregnancy rates and fertility outcomes in patients with intrauterine adhesions (IUA).
A retrospective analysis was conducted on 105 patients with IUA treated at Baoji Maternal and Child Health Hospital from June 2022 to December 2023. All patients underwent hysteroscopic adhesiolysis. Based on the adjunctive treatment, patients were divided into two groups: the observation group (n=55), which received adhesiolysis plus balloon uterine stent placement, and the control group (n=50), which received adhesiolysis alone. We compared clinical efficacy, changes in endometrial thickness, menstrual volume, and serum estrogen levels, including estrogen receptor (ER) and progesterone receptor (PR) levels, between the two groups. Additionally, we recorded and compared the 3-month postoperative recurrence rate of IUA, pregnancy rates and outcomes, and complications. The predictive value of ER and PR levels for postoperative pregnancy was also analyzed. We then compared the general data of patients who became pregnant after surgery with those who did not, and used multivariate logistic regression to analyze the factors influencing postoperative non-pregnancy.
The overall treatment efficacy was significantly higher in the observation group than in the control group (P<0.05). The observation group showed significantly greater improvements in endometrial thickness, menstrual volume, and serum estrogen levels compared to the control group (all P<0.05). The recurrence rate of adhesions during follow-up was significantly lower in the observation group than in the control group (P<0.05). The postoperative pregnancy rates and fertility outcomes were also significantly better in the observation group (both P<0.05). The sensitivity and specificity of ER levels in predicting postoperative pregnancy were 78.05% and 70.31%, respectively, with an AUC of 0.788. For PR levels, the sensitivity was 75.61%, specificity was 71.88%, and AUC was 0.834. Multivariate regression analysis indicated that age, adhesion severity, adhesion recurrence, and the use of a balloon uterine stent were independent risk factors affecting postoperative pregnancy in patients with IUA (P<0.05).
The combination of adhesiolysis and intrauterine balloon stent placement in patients with moderate to severe intrauterine adhesions significantly IUA increases endometrial thickness and volume, promotes menstrual recovery, prevents re-adhesion, and improves pregnancy outcomes. This approach is recommended for clinical application.
探讨宫腔镜下粘连松解术对宫腔粘连（IUA）患者术后妊娠率及生育结局的长期影响。
对2022年6月至2023年12月在宝鸡市妇幼保健院接受治疗的105例IUA患者进行回顾性分析。所有患者均接受宫腔镜下粘连松解术。根据辅助治疗方法，将患者分为两组：观察组（n = 55），接受粘连松解术加球囊子宫支架置入；对照组（n = 50），仅接受粘连松解术。比较两组的临床疗效、子宫内膜厚度变化、月经量及血清雌激素水平，包括雌激素受体（ER）和孕激素受体（PR）水平。此外，记录并比较两组术后3个月IUA的复发率、妊娠率及结局和并发症。分析ER和PR水平对术后妊娠的预测价值。然后比较术后妊娠患者与未妊娠患者的一般资料，并采用多因素logistic回归分析影响术后未妊娠的因素。
观察组的总体治疗效果显著高于对照组（P < 0.05）。与对照组相比，观察组的子宫内膜厚度、月经量及血清雌激素水平改善更为显著（均P < 0.05）。随访期间观察组粘连复发率显著低于对照组（P < 0.05）。观察组术后妊娠率及生育结局也显著更好（均P < 0.05）。ER水平预测术后妊娠的敏感性和特异性分别为78.05%和70.31%，AUC为0.788。PR水平的敏感性为75.61%，特异性为71.88%，AUC为0.834。多因素回归分析表明，年龄、粘连严重程度、粘连复发及球囊子宫支架的使用是影响IUA患者术后妊娠的独立危险因素（P < 0.05）。
对于中重度宫腔粘连患者，粘连松解术联合宫腔球囊支架置入可显著增加子宫内膜厚度和容积，促进月经恢复，预防再次粘连，并改善妊娠结局。该方法推荐临床应用。
