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目的探讨宫腔镜下宫腔粘连切除术(TCRA)前后微血管密度(MVD)及血管内皮生长因子(VEGF)在重度宫腔粘连子宫内膜表达的差异及其临床意义。方法选择60例重度宫腔粘连患者,其中Ⅳ度宫腔粘连37例、Ⅴ度宫腔粘连23例。所有宫腔粘连患者行TCRA后予雌激素为主的人工周期治疗。检测术前、术后3个月60例患者子宫内膜中CD34标记的MVD及VEGF表达水平。结果 60例患者的手术过程均顺利,术中无一例发生大量出血、水中毒、子宫穿孔等并发症,术后随访均未见盆腔感染。TCRA术前、术后3个月,60例宫腔粘连患者的子宫内膜组织中均有CD34及VEGF表达。TCRA术后3个月患者子宫内膜的MVD、VEGF评分均高于术前(P均<0.01)。术后3个月,Ⅳ度宫腔粘连、月经中期子宫内膜厚度≥7 mm、粘连无复发患者的子宫内膜MVD、VEGF评分均相应高于Ⅴ度宫腔粘连、子宫内膜<7 mm、粘连复发患者(P均<0.01)。结论宫腔粘连子宫内膜修复过程中MVD、VEGF表达上调,提示微血管的新生可能有利于TCRA术后子宫内膜修复。
Objective To investigate the difference of microvessel density (MVD) and expression of vascular endothelial growth factor (VEGF) in severe intrauterine adhesions endometrium before and after hysteroscopic hysteroscopic adhesion resection (TCRA) and its clinical significance. Methods Sixty patients with severe intrauterine adhesions were selected, in which there were 37 cases with degree Ⅳ intrauterine adhesions and 23 cases with degree Ⅴ intrauterine adhesions. All patients with intrauterine adhesions underwent estrogen-based artificial cycle therapy after TCRA. The levels of CD34-labeled MVD and VEGF in endometrium of 60 patients before and 3 months after operation were measured. Results The operation of 60 patients was successful. None of the patients had massive bleeding, water poisoning and perforation of the uterus during operation. No pelvic infection was found after follow-up. TCRA preoperative and postoperative 3 months, 60 cases of intrauterine adhesions in patients with endometrial tissue CD34 and VEGF expression. The endometrial MVD and VEGF scores of patients at 3 months after TCRA were higher than those before operation (all P <0.01). At 3 months after operation, IV degree intrauterine adhesions and mid-menstrual endometrial thickness were ≥7 mm, MVD and VEGF scores in patients with adhesion-free recurrence were all higher than those in V degree intrauterine adhesions, and the endometrium was less than 7 mm , Adhesion and recurrence patients (all P <0.01). Conclusion The expression of MVD and VEGF in uterine cavity during endometrial repair is up-regulated, suggesting that the newborn of microvascular may be beneficial to the endometrial repair after TCRA.