Effect of different surgical approaches for intrauterine adhesions patients on pregnancy outcomes.

Q3 Medicine
Ping Guo, Meiqin Chen, Shan Liu, Wei Peng, Xingping Zhao, Hualian Chen
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引用次数: 0

Abstract

Objectives: 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).

Conclusions: 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.

不同手术入路对宫内粘连患者妊娠结局的影响。
目的:宫腔镜下经宫颈粘连切除术(TCRA)是治疗宫内粘连(IUA)的主要方法,但其疗效因手术入路的不同而不同。本研究旨在探讨不同手术技术对继发性不孕症和中重度IUA患者子宫内膜修复和妊娠结局的影响。方法:回顾性分析2021年1月至2022年12月期间接受TCRA后体外受精和胚胎移植的225例患者。根据手术方式将患者分为冷刀组(127例)和电刀组(98例)。用冷刀或电手术器械分离粘连。比较术后子宫角和输卵管口的显像、子宫内膜修复、粘连组织中血管内皮生长因子(VEGF)的表达及临床妊娠结局。采用单因素和多因素Logistic回归分析确定影响妊娠结局的因素。建立LightGBM模型预测妊娠结局。结果:与电刀组相比,冷刀组患者术后子宫内膜厚度((8.86±0.53)mm vs(8.10±0.87)mm, ppppp显著增加。冷刀手术促进继发性不孕症和IUA患者子宫内膜微环境更快恢复,生育能力更早改善。手术方式是影响妊娠结局的关键因素,基于手术方式的LightGBM模型对中重度IUA患者的妊娠结局有较好的预测效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
中南大学学报(医学版)
中南大学学报(医学版) Medicine-Medicine (all)
CiteScore
1.00
自引率
0.00%
发文量
8237
期刊介绍: Journal of Central South University (Medical Sciences), founded in 1958, is a comprehensive academic journal of medicine and health sponsored by the Ministry of Education and Central South University. The journal has been included in many important databases and authoritative abstract journals at home and abroad, such as the American Medline, Pubmed and its Index Medicus (IM), the Netherlands Medical Abstracts (EM), the American Chemical Abstracts (CA), the WHO Western Pacific Region Medical Index (WPRIM), and the Chinese Science Citation Database (Core Database) (CSCD); it is a statistical source journal of Chinese scientific and technological papers, a Chinese core journal, and a "double-effect" journal of the Chinese Journal Matrix; it is the "2nd, 3rd, and 4th China University Excellent Science and Technology Journal", "2008 China Excellent Science and Technology Journal", "RCCSE China Authoritative Academic Journal (A+)" and Hunan Province's "Top Ten Science and Technology Journals". The purpose of the journal is to reflect the new achievements, new technologies, and new experiences in medical research, medical treatment, and teaching, report new medical trends at home and abroad, promote academic exchanges, improve academic standards, and promote scientific and technological progress.
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