Effect of GnRHa on intrauterine adhesions and pregnancy outcomes in women of childbearing age with type II submucous uterine myoma after electrotomy

Abstract:

Objective：To investigate the effect of GnRHa on intrauterine adhesions and pregnancy outcomes in women of childbearing age with type Ⅱ submucous uterine myoma after electrotomy. Methods：Fifty-eight patients were enrolled in the study who were di－agnosed with type Ⅱ submucosal uterine myoma and underwent hysteroscopic resection in our hospital from May 2015 to May 2017. According to whether GnRHa was used or not before the operation，these patients were divided into GnRHa group（A group） and non-GnRHa group（B group）. In the A group，all 30 cases received hysteroscopic resection after three cycles of GnRHa treatment，while in the B group，all 28 cases received the same surgery without GnRHa treatment. The operation time，intraoperative blood loss，and dis－tention volume were recorded in both groups. Hysteroscopy was performed again one month later to evaluate the condition of uterine cavity and record the occurrence of intrauterine adhesions. Some endometrial tissues were then collected，and immunohistochemistry was used to determine the expression of collagen typeⅠ（Col-Ⅰ），connective tissue growth factor（CTGF），and transforming growth factor-β1（TGF-β1）. The pregnancy outcome was followed up for 6 to 12 months after attempted pregnancy. Results：The mean time of operation in the A group and B group was （40.90±15.09） min and 52.9±13.5 min，respectively，and the mean intraoperative blood loss in both groups was （27.0±14.4） mL and （52.3±17.5） mL，respectively. There were significant differences between these two groups regarding the time of operation and intraoperative blood loss（P<0.05）. The incidence rate of intrauterine adhesions was 6.7%（2/30） in the A group and 7.7%（2/26） in the B group af－ter hysteroscopic resection，showing no significant difference be－tween these two groups（P>0.05）. There were no significant dif－ferences in the expression of Col-Ⅰ，CTGF，and TGF-β1 be－tween the two groups（P>0.05）. All cases were followed up for 6 to 12 months after attempted pregnancy，and the postoperative pregnancy rate was 72% in the A group and 68.2% in the B group，giving no significant difference（P>0.05）. Conclusion：GnRHa pretreatment significantly shortens the time of operation and reduces intraoperative blood loss，but fails to alleviate postoperative in－trauterine adhesions and improve the pregnancy of the patients.