宫腔粘连一级预防的全面策略

Comprehensive strategies for primary prevention of intrauterine adhesions

宫腔粘连(intrauterine adhesion,IUA)是由于子宫内膜损伤导致宫腔部分或完全闭塞。临床表现为月经量减少,甚至闭经,不孕及周期性腹痛等,妊娠早期易发生反复流产,妊娠晚期常出现胎盘植入、早产及产后出血等,导致生殖功能严重受损,一旦发生IUA治疗比较棘手。目前,IUA的治疗主要是宫腔镜下宫腔粘连分离术(hysteroscopic adhesiolysis,TCRA),但术后粘连复发率最高可达62.5%。所以预防IUA的发生比治疗更为重要。宫腔操作和感染是导致IUA发生的主要原因,积极预防和治疗宫腔感染,规范宫腔操作,结合术后辅助预防方法,如凝胶屏障、物理屏障及激素疗法等保护子宫内膜,能有效预防IUA的发生。其他的预防选择,如干细胞治疗、外泌体和富血小板血浆等尚处于研究当中。该研究现就IUA的一级预防进行综述,以期提供临床指导。

Intrauterine adhesions(IUAs)are caused by damage to the endometrium,resulting in partial or complete occlusion of the uterine cavity.The clinical manifestations include reduced menstrual flow,even amenorrhea,infertility,periodic abdominal pain,and so on.Recurrent miscarriage is prone to occur in the early stages of pregnancy,while placental implantation,premature delivery,and postpartum hemorrhage often occur in the late stages of pregnancy,leading to serious damage to reproductive function.Once IUA occurs,it is difficult to treat.At present,the main treatment for IUA is hysteroscopic adhesiolysis(TCRA),but the recurrence rate of postoperative adhesions is as high as 62.5%.Therefore,prevention of IUA is more important than treatment.Intrauterine operation and infection are the main causes of IUA.Active prevention and treatment of uterine cavity infection,standardized intrauterine operation,combined with postoperative adjuvant prevention methods,such as gel barrier,physical barrier and hormone therapy,can effectively prevent the occurrence of IUA.Other prevention options,such as stem cell therapy,exosomes and platelet-rich plasma,are still under study.The study reviews the primary prevention of IUA in order to provide clinical guidance.