宫腔粘连分离术后预防粘连复发的方法及研究进展

Methods and Research Advances in Prevention of the Recurrence of IUA after Hysteroscopic Adhesiolysis

宫腔粘连(intrauterine adhesions,IUA)是指由于多种因素导致子宫内膜基底层受损,临床症状主要表现为月经异常、不孕、复发性流产及早产、胎盘异常等产科相关并发症。宫腔镜手术是治疗IUA的标准术式,但是中、重度IUA患者术后的复发率较高,严重影响患者的生殖预后。目前临床上预防术后粘连复发的方法包括雌激素或其他药物促进内膜修复、宫腔内放置支架、透明质酸抑制创面炎症反应、宫腔内放置羊膜制品、宫腔镜二次探查、治疗慢性子宫内膜炎等。还有一些尚在研究阶段的新措施,如宫腔注射促子宫内膜生长因子、干细胞治疗等。在临床实际应用过程中,目前尚无统一的治疗方案,多采取多种措施综合治疗。

Intrauterine adhesions(IUA)refers to the damage of endometrial basal layer caused by many factors.Patients with IUA may present with menstrual abnormalities,infertility,recurrent miscarriages.Sequelae of pregnancy in the presence of adhesions include higher incidences of premature labor,and abnormal placentation.Hysteroscopic surgery is the standard operation for the treatment of IUA.However,the recurrence rate of adhesions in patients with moderate to severe IUA is high,which seriously affects the reproductive prognosis of patients.At present,the clinical methods to prevent postoperative adhesion recurrence include promoting endometrial growth and repair with estrogen or other drugs,stent placement in the uterine cavity,inhibiting the inflammatory reaction of the wound with hyaluronic acid,amniotic membrane products placement in the uterine cavity,second-look hysteroscopy,treatment of chronic endometritis,etc.There are still some new measures in the research stage,such as intrauterine injection of endometrial growth factor,stem cell therapy and so on.In the clinical practice,there is no unified treatment plan nowadays,and most patients are treated with a combination regimen.