新鲜羊膜移植对中、重度宫腔粘连月经模式的影响

Effect of fresh amnion graft on menstrual pattern for patients with moderate to severe intrauterine adhesion

目的:探讨新鲜羊膜移植对中、重度宫腔粘连患者行宫腔镜宫腔粘连分离术(transcervical resection of adhesions,TCRA)后月经模式的影响。方法:选择2015年1至12月于我院宫腔镜检查确诊的46例表现为月经过少或闭经的中重度宫腔粘连患者,分为羊膜移植组(24例)和几丁糖组(22例)。羊膜移植组在TCRA术后行新鲜羊膜移植,几丁糖组在TCRA术后宫内注射几丁糖。术后1、3个月行B超及宫腔镜检查,随访观察子宫内膜厚度及月经改善情况。结果:所有患者手术过程均顺利且无相关并发症。羊膜移植组和几丁糖组患者月经完全或显著改善分别为87.5%(21/24)、50%(11/22);羊膜移植组总有效率为100%(24/24),几丁糖组总有效率为81.8%(18/22)。经统计分析,羊膜移植组子宫内膜厚度和月经持续时间优于几丁糖组,差异具有统计学意义(P1=0.002,P2=0.025);但2组月经改善总有效率比较,差异无统计学意义(P=0.096)。结论:TCRA术后将新鲜羊膜移植入宫腔能在一定程度上优化宫腔粘连患者月经情况,为宫腔粘连患者提高生育率提供了新的希冀。

Objective:To explore the effect of fresh amnion graft on the menstrual pattern after transcervical resection of adhesions(TCRA)for patients with moderate to severe intrauterine adhesions(IUA). Methods:Forty-six patients with IUA who presented with a history of hypomenorrhea,amenorrhea were included in the study from January 2015 to December. Patients were divided into amnion group(24 patients)and chitosan group(22 patients). Fresh amnion grafts or intrauterine injections of chitosan were administered after TCRA. Transvaginal ultrasonography and hysteroscopy were performed at 1 and 3 months after the operation. Endometrial thickness,menstrual pattern were recorded. Results:The surgical procedures for all women were completed without relevant complications. Patients with normal or marked improvement rates in menstruation in amnion group and chitosan group were 87.5%(21/24)and 50%(11/22),respectively. The total effective rate was 100%(24/24)and 81.8%(18/22)in amnion group and chitosan group. Statistical analysis revealed that the endometrial thickness and menstrual duration of amnion group were significantly better than those of chitosan group(P1=0.002,P2=0.025);but there was no significant difference in the total effective rate of menstrual improvement between the two groups(P=0.096). Conclusion:After TCRA,the use of fresh amnion graft can optimize the menstruation to a certain extent,which brings hope to women with IUA by increasing their chance of conception.