两种宫腔镜下宫腔粘连分离术对人子宫内膜形态及功能的影响

发布时间：2019-03-28 12:54

【摘要】：目的:拟通过两种不同的TCRA来研究手术对宫腔粘连的子宫内膜形态及功能的影响,寻求更合理的手术方法和探讨宫腔粘连的发生及内膜修复机制。方法:将2015年12月至2016年6月就诊于遵义市妇幼保健院的轻中度宫腔粘连患者40例,随机按诊断日期的单双号分为2组,其中1组20例行宫腔镜电切分离粘连,2组20例行宫腔镜下金属弯钩分离粘连,观察比较手术前及手术后1-3个月内两组患者月经、子宫内膜厚度、子宫腔形态大小、子宫内膜腺体细胞数目的差异以及子宫内膜雌激素受体(ER)、血小板-内皮细胞粘附分子(CD31)、转化生长因子β1(TGF-β1)、白血病抑制因子(LIF)在子宫内膜的表达量的差异。结果:1、月经、子宫内膜厚度、宫腔形态,与治疗前相比,1组和2组均具有良好的改善率(P0.05),组间无显著性差异(P0.05),其中在宫腔形态基本改善上,2组优于1组且存在差异(P0.05)。2、子宫内膜腺体细胞数目,与治疗前相比,1组和2组均总体下降且差异显著(P0.05),组间无显著性差异(P0.05)。3、ER、TGF-β1、CD31、LIF与治疗前相比,1组和2组均差异显著(P0.05),但组间无显著性差异(P0.05);其中治疗前后ER、TGF-β1呈下降趋势,CD31、LIF呈上升趋势。结论:1、两种宫腔镜手术治疗轻中度宫腔粘连,在1-3月内观察效果均满意,疗效无显著差异;但宫腔形态的基本改善方面,2组明显优于1组,可能与扩张宫颈内口及电切镜与宫颈内口反复摩擦有关。因此,要提高手术疗效,器械的改进是必要的。2、两种手术均会在短期内导致子宫内膜腺体细胞数目减少,可能与手术引起的再次创伤有关;3.两种手术均能改善子宫内膜功能状态,即通过下调ER、TGF-β1表达来降低子宫粘连和成纤维化程度,同时通过上调CD31和LIF表达而增加子宫血管生成和子宫容受性。
[Abstract]:Aim: to study the effect of two different TCRA on the shape and function of endometrium in uterine cavity adhesion, to find more reasonable surgical methods and to explore the mechanism of uterine cavity adhesion and intimal repair. Methods: from December 2015 to June 2016, 40 patients with mild or moderate uterine adhesions were randomly divided into two groups according to the date of diagnosis, among them, 20 patients in group 1 were treated by hysteroscopic electroresection and adhesion was separated by hysteroscopy, and the patients were divided into two groups at random according to the date of diagnosis. Two groups (20 cases) were treated with metal hook separation and adhesion under hysteroscopy. The menstruation, endometrial thickness and size of uterus cavity were observed and compared before operation and 1 month after operation. The difference in the number of endometrial glandular cells and the expression of platelet-endothelial cell adhesion molecule (CD31) and transforming growth factor 尾 1 (TGF- 尾 1) in endometrial estrogen receptor (ER),). The difference of expression of leukemic inhibitory factor (LIF) in endometrium. Results: 1, menstruation, endometrial thickness, uterine cavity shape, compared with before treatment, group 1 and group 2 had a good improvement rate (P0.05), there was no significant difference between groups (P0.05), in which the shape of uterine cavity was basically improved, and there was no significant difference between the two groups (P0.05), and there was no significant difference between the two groups (P0.05). The number of endometrial glandular cells in group 1 and group 2 was significantly lower than that in group 1 (P0.05), but there was no significant difference between group 1 and group 2 (P0.05). Compared with pre-treatment, TGF- 尾 1 and CD31,LIF in group 1 and group 2 were significantly different (P0.05), but there was no significant difference between groups (P0.05). Among them, ER,TGF- 尾 1 decreased and CD31,LIF increased before and after treatment. Conclusion: 1. The curative effect of the two kinds of hysteroscopic surgery in the treatment of mild and moderate uterine adhesions is satisfactory within 1-3 months, and there is no significant difference in the curative effect. However, the basic improvement of uterine cavity morphology in the two groups was obviously superior to that in the first group, which might be related to the dilation of the internal mouth of the cervix and the repeated friction between the endoscope and the internal mouth of the cervix. Therefore, to improve the efficacy of surgery, it is necessary to improve the instrument. 2, both operations will lead to a short-term reduction in the number of endometrial glandular cells, which may be related to the re-trauma caused by surgery; 3. Both operations could improve the endometrial function by down-regulating the expression of ER,TGF- 尾 1 to reduce the degree of uterine adhesion and fibrosis, and increase uterine angiogenesis and uterine receptivity by up-regulating the expression of CD31 and LIF.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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