Frontiers in medicine · 2026
Dynamic perioperative inflammatory biomarkers predict intrauterine adhesion formation following hysteroscopic myomectomy: a prospective cohort study.
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Liu Mei, Zhou Qing, Zhang Wenzhu, Shen Jian
Аннотация
BACKGROUND: Intrauterine adhesions (IUAs) are a common complication following hysteroscopic submucosal myomectomy and are closely linked to impaired endometrial healing. The role of perioperative inflammatory biomarkers in predicting adhesion formation remains incompletely defined.
METHODS: This prospective cohort study included 140 women undergoing hysteroscopic submucosal myomectomy at a tertiary care center between April 2024 and October 2025. Serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) were measured preoperatively, at 48 h, and at 12 weeks postoperatively. IUAs were assessed by second-look hysteroscopy and graded according to American Fertility Society criteria. Multivariable logistic regression and correlation analyses were performed to identify predictors of adhesion formation.
RESULTS: IUAs developed in 42 patients (30.0%). Baseline characteristics were comparable between groups; however, FIGO type II fibroids and longer operative time were significantly associated with adhesion formation (p < 0.05). At 48 h postoperatively, IL-6 and CRP levels were significantly higher in the IUA group compared to the non-IUA group (both p < 0.001), while TNF-α showed a smaller increase. IL-6 demonstrated the strongest correlation with adhesion severity (ρ = 0.54, p < 0.001), followed by CRP (ρ = 0.46, p < 0.001). In multivariable analysis, IL-6 (adjusted OR = 1.24, 95% CI: 1.10-1.40) and CRP (adjusted OR = 1.31, 95% CI: 1.07-1.60) were independent predictors of moderate-to-severe IUAs, whereas TNF-α was not significant.
CONCLUSION: Perioperative inflammatory response, particularly elevated IL-6 and CRP levels, is strongly associated with intrauterine adhesion formation following hysteroscopic myomectomy. Early postoperative biomarker assessment may provide a valuable strategy for risk stratification and targeted prevention of IUAs.
METHODS: This prospective cohort study included 140 women undergoing hysteroscopic submucosal myomectomy at a tertiary care center between April 2024 and October 2025. Serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) were measured preoperatively, at 48 h, and at 12 weeks postoperatively. IUAs were assessed by second-look hysteroscopy and graded according to American Fertility Society criteria. Multivariable logistic regression and correlation analyses were performed to identify predictors of adhesion formation.
RESULTS: IUAs developed in 42 patients (30.0%). Baseline characteristics were comparable between groups; however, FIGO type II fibroids and longer operative time were significantly associated with adhesion formation (p < 0.05). At 48 h postoperatively, IL-6 and CRP levels were significantly higher in the IUA group compared to the non-IUA group (both p < 0.001), while TNF-α showed a smaller increase. IL-6 demonstrated the strongest correlation with adhesion severity (ρ = 0.54, p < 0.001), followed by CRP (ρ = 0.46, p < 0.001). In multivariable analysis, IL-6 (adjusted OR = 1.24, 95% CI: 1.10-1.40) and CRP (adjusted OR = 1.31, 95% CI: 1.07-1.60) were independent predictors of moderate-to-severe IUAs, whereas TNF-α was not significant.
CONCLUSION: Perioperative inflammatory response, particularly elevated IL-6 and CRP levels, is strongly associated with intrauterine adhesion formation following hysteroscopic myomectomy. Early postoperative biomarker assessment may provide a valuable strategy for risk stratification and targeted prevention of IUAs.