摘要
目的:宫腔镜下粘连分离术(transcervical resection of adhesions,TCRA)是目前治疗宫腔粘连(intrauterine adhesions,IUA)的主要方法,但不同手术方式的效果不同。本研究旨在探讨继发性不孕合并中重度IUA患者应用不同手术方式的TCRA对其术后内膜修复和妊娠结局的影响。方法:回顾性纳入2021年1月至2022年12月行TCRA后体外受精-胚胎移植的患者225例,依据手术方式分为冷刀组(n=127)和电切组(n=98),分别行冷刀、电切分离粘连。比较2组患者术后宫角和输卵管口可见情况、内膜修复情况、宫腔粘连组织血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达及临床妊娠结局。采用单因素和多因素逻辑回归分析筛选对妊娠结局有影响的变量,使用LightGBM算法构建预测妊娠结局的模型。结果:与电切组比较,冷刀组患者的术后子宫内膜厚度增加[(8.86±0.53)mm vs(8.10±0.87)mm,P<0.05],术后活产率提高(64.57%vs 30.61%,P<0.05),而VEGF表达降低(1.31±0.09 vs 1.53±0.16,P<0.05)。单因素和多因素逻辑回归分析结果显示年龄、术后输卵管口可见数和手术方式对妊娠结局有显著影响(均P<0.05)。基于手术方式建立的LightGBM模型的曲线下面积(area under the curve,AUC)为0.882(0.838~0.926),内部验证的AUC为0.817(0.790~0.840)。结论:应用冷刀手术治疗继发性不孕合并IUA患者,其子宫内膜微环境恢复更快,生育能力改善更早。手术方式是影响妊娠结局的一个重要因素,基于手术方式建立的LightGBM模型对中重度IUA患者的妊娠结局有良好的预测性。
Objective:Transcervical resection of adhesions(TCRA)under hysteroscopy is the mainstay treatment for intrauterine adhesions(IUA),but its effectiveness varies depending on the surgical approach.This study aims to investigate the impact of different surgical techniques on endometrial repair and pregnancy outcomes in patients with secondary infertility and moderate-to-severe IUA.Methods:A retrospective analysis was conducted on 225 patients who underwent TCRA followed by in vitro fertilization and embryo transfer between January 2021 and December 2022.Patients were grouped based on the surgical method:A cold knife group(n=127)and an electrosurgical group(n=98).Adhesions were separated using either cold knife or electrosurgical instruments.Postoperative visualization of uterine angle and tubal ostia,endometrial restoration,vascular endothelial growth factor(VEGF)expression in adhesion tissues,and clinical pregnancy outcomes were compared.Univariate and multivariate Logistic regression analyses were performed to identify factors influencing pregnancy outcomes.A LightGBM model was constructed to predict pregnancy outcomes.Results:Compared with the electrosurgical group,patients in the cold knife group had significantly greater postoperative endometrial thickness[(8.86±0.53)mm vs(8.10±0.87)mm,P<0.05],higher live birth rates(64.57%vs 30.61%,P<0.05),and lower VEGF expression(1.31±0.09 vs 1.53±0.16,P<0.05).Logistic regression analyses identified age,number of visible tubal ostia postoperatively,and surgical method as significant factors affecting pregnancy outcomes(P<0.05).The LightGBM model based on surgical method had an area under the curve(AUC)of 0.882(0.838−0.926),with internal validation AUC of 0.817(0.790−0.840).Conclusion:Cold knife surgery promotes faster recovery of the endometrial microenvironment and earlier improvement of fertility in patients with secondary infertility and IUA Surgical method is a key factor influencing pregnancy outcomes,and the LightGBM model based on surgical approach shows good predictive performance for pregnancy outcomes in patients with moderate-to-severe IUA.
作者
郭萍
陈美琴
刘珊
彭伟
赵行平
陈华莲
GUO Ping;CHEN Meiqin;LIU Shan;PENG Wei;ZHAO Xingping;CHEN Hualian(Department of Gynecology,Yichun Maternal and Child Health Hospital of Jiangxi Province,Yichun 336000;Department of Gynecology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Obstetrics and Gynecology,People’s Hospital of Changsha County,Changsha 410100,China)
出处
《中南大学学报(医学版)》
北大核心
2025年第3期482-491,共10页
Journal of Central South University :Medical Science
基金
芙蓉实验室技术攻关项目(2023SK2109)。
关键词
宫腔粘连
宫腔镜
血管内皮生长因子
妊娠结局
冷刀手术
intrauterine adhesions
hysteroscopy
vascular endothelial growth factor
pregnancy outcome
cold knife surgery
作者简介
第一作者:郭萍,Email:gping202@126.com,ORCID:0009-0008-4614-2537;通信作者:陈华莲,主任医师,Email:ailianchen12@163.com,ORCID:0009-0006-1922-0902。
