中重度宫腔粘连分离术后预防宫腔再粘连的临床效果观察

目的:探讨中重度宫腔粘连分离术后预防宫腔再粘连的临床效果。方法:回顾性分析2013年1月至2014年6月在武汉大学人民医院就诊的119例经宫腔镜检查确诊为中重度宫腔粘连并行TCRA术患者的临床资料。术后宫腔放置Foley球囊导尿管+宫内节育器为A组,宫腔放置Foley球囊导尿管+宫内节育器+可吸收医用膜为B组,术后均使用人工周期。比较患者的术后月经改善、宫腔及妊娠情况。结果:中度宫腔粘连患者中,B组的治愈率高于A组(57.7%vs 31.0%,P=0.047),宫腔再粘连率低于A组(15.4%vs 44.8%,P=0.018);A、B组的妊娠率分别为40%、60%,差异无统计学意义(P=0.37)。重度宫腔粘连患者中,B组的治愈率高于A组(43.8%vs 18.8%,P=0.031),宫腔再粘连率低于A组(15.6%vs 46.9%,P=0.007);A、B组的妊娠率分别为11.1%和33.3%,差异无统计学意义(P=0.257)。结论:中重度宫腔粘连分离术后联合使用Foley球囊导尿管+宫内节育器+可吸收医用膜治疗效果优于Foley球囊导尿管+宫内节育器组。     

重度宫腔粘连分离术后预防再粘连方法的比较

目的评估宫腔镜宫腔粘连分离术后预防宫腔再粘连方法的疗效。方法回顾性分析2004年11月至2007年5月间郑州大学第三附属医院妇科内镜诊治中心122例宫腔镜下宫腔粘连切除术患者的临床资料。术后宫腔内放置节育环(IUD)58例为IUD组,宫腔注入几丁糖并IUD64例为IUD+几丁糖组;根据病程长短将IUD组分为Ia组(病程≤1年)和Ib组(病程1年),IUD+几丁糖组分为IIa组(病程≤1年)和IIb组(病程1年)。观察术后宫腔恢复情况、月经改善及妊娠情况。结果IUD和IUD+几丁糖组术后宫腔再粘连率分别为41.4%和23.4%(P0.05),其中Ia组(19.0%)明显低于Ib组(54.1%)(P0.05);IUD组月经改善率及妊娠率分别为74.1%和29.3%,IUD+几丁糖组分别为92.2%和48.4%,IUD组明显低于IUD+几丁糖组(P0.05),其中Ia组(90.0%、47.6%)明显高于Ib组(64.9%、18.9%)(P0.05)。IIa组术后宫腔再粘连率及妊娠率分别为8.7%和78.3%,IIb组分别为31.7%和31.7%,两组比较,差异均有统计学意义(P0.05);IIa组(100%)月经改善率与IIb组(87.8%)比较,差异无统计学意义(P0.05)。结论重度宫腔粘连切除术后宫腔内放置节育环加几丁糖可有效预防再粘连,提高月经改善率及妊娠率。     

宫腔粘连术后留置玻璃酸钠联合大剂量雌激素预防再发粘连

目的:观察宫腔粘连(IUA)分解术后宫腔内放入玻璃酸钠联合大剂量雌激素口服预防再粘连的效果。方法:宫腔镜确诊为IUA患者272例,分为A组和B组,A组(n=103)行宫腔镜下IUA分离术及宫腔内节育器(IUD)放置术,术后口服大剂量雌激素及孕激素人工周期3个月;B组(n=169)在A组相同治疗的基础上加宫腔内留置玻璃酸钠;比较A组和B组的疗效。结果:中度粘连患者术后粘连再发率B组显著低于A组(P0.05);A、B组的治疗有效率分别为:轻度粘连100%、100%;中度粘连83.3%、94.6%;重度粘连68.2%、83.9%(P均0.05);轻、中度IUA的治愈率B组显著高于A组(P0.05)。结论:IUA分解术后宫腔内留置玻璃酸钠联合大剂量雌激素口服可提高预防再粘连的效果,特别对轻、中度IUA效果显著。     

重度宫腔粘连分离术后不同方法预防再粘连的比较研究

目的:比较重度宫腔粘连宫腔镜下宫腔粘连切除术(TCRA)后预防再次粘连的3种治疗方法的临床疗效。方法:选择2005年1月1日至2014年12月31日于绵阳市中心医院行TCRA的重度宫腔粘连患者共计157例。分为3组:几丁糖组51例,术后宫腔注入几丁糖2 ml;IUD组50例,术后放置IUD;几丁糖+IUD组56例,术后宫腔注入几丁糖同时放置IUD;几丁糖组及几丁糖+IUD组术后均安置阴道隔膜24小时,术后3个月宫腔镜下观察宫腔情况。结果:几丁糖组、IUD组、几丁糖+IUD组3组预防宫腔再粘连有效率分别为47.1%、32.0%及64.3%,3组比较差异有统计学意义(P=0.004);再粘连率分别为86.3%、92.0%及69.6%,3组比较差异有统计学意义(P=0.007)。结论:TCRA术后宫腔注入几丁糖与放置IUD联合应用,可明显提高宫腔粘连治疗有效率,降低术后再次粘连的发生。     

宫腔镜下宫腔粘连分离术后预防再粘连方法比较

目的:探讨宫腔镜下宫腔粘连分离术(TCRA)后宫内节育器(IUD)、球囊支架及Interceed防粘连膜(简称Interceed)预防再粘连的疗效。方法:173例(轻中度72例,重度101例)宫腔镜下诊断为宫腔粘连(IUA)并成功行TCRA的患者,按术后预防再粘连使用的不同方法分为IUD组(65例)、球囊支架组(47例)、Interceed组(61例)。术后随访患者月经改善情况,结合宫腔镜复查结果,比较3种方法的疗效。结果:轻中度IUA患者,IUD组、球囊支架组、Interceed组的有效率分别为77.78%、85.71%、83.33%,3组比较差异无统计学意义(P0.05);重度IUA患者,有效率分别为47.37%、73.08%、72.97%,球囊支架和Interceed分别与IUD组比较,差异有统计学意义(P0.05)。术后3个月复查宫腔镜,球囊支架组患者中宫腔形态完全恢复正常的比例高于Interceed组(48.94%vs 34.43%,P0.05);术后3个月取出的球囊支架进行细菌培养,发现球囊支架组的细菌阳性率较IUD组明显升高(34.04%vs 12.31%,P0.05)。结论:对于轻中度IUA患者,3种材料预防再粘连效果均较好;而对于重度IUA患者,球囊支架与Interceed预防再粘连的效果优于IUD;但球囊支架和Interceed预防再粘连各有不足,还需要寻求更合适的生物材料。     

宫腔冲洗引流在重度宫腔粘连患者宫腔镜下宫腔粘连分离术后的应用效果研究

目的:评价宫腔冲洗引流在重度宫腔粘连患者宫腔镜下宫腔粘连分离术(TCRA)后的临床应用效果。方法:选择2019年1～12月在郑州大学第三附属医院就诊的重度宫腔粘连患者86例作为研究对象,根据术后预防再粘连的方法不同分为3组:A组30例,术后放置二腔球囊导管引流,B组30例,术后放置三腔球囊导管+0.9%氯化钠液冲洗引流,C组26例,术后放置三腔球囊导管+抗生素冲洗引流。比较3组患者宫腔引流量、子宫内膜厚度、月经评分、宫腔形态、满意度、妊娠结局及不良反应发生情况。结果:术后6个月3组患者子宫内膜厚度、月经评分、宫腔形态均较术前改善,差异均有统计学意义(P<0.05);B、C两组术后总引流液量、子宫内膜厚度、月经评分、宫腔形态改善率均高于A组,差异有统计学意义(P<0.05),B、C两组间比较,差异无统计学意义(P>0.05);3组不良反应、妊娠情况、满意情况比较差异无统计学意义(P>0.05)。结论:TCRA后放置三腔球囊导管行冲洗引流相比放置二腔球囊导管被动引流更能有效预防重度宫腔粘连术后再粘连的发生,增加患者子宫内膜厚度,有效改善月经情况,采用0.9%氯化钠液或抗生素冲洗宫腔对比术后治疗效果无明显差别。     

放置防粘连膜或注水球囊预防重度宫腔粘连术后复发疗效研究

目的探讨放置防粘连膜或注水球囊预防重度宫腔粘连术后复发的疗效。方法回顾性分析2009年6月至2014年6月南方医科大学附属深圳妇幼保健院收治的80例重度宫腔粘连患者,所有病人均行宫腔镜下宫腔粘连分离术(TCRA),术后服用戊酸雌二醇3个月。根据术后处理方法分成3组。A组(34例):术后放置宫内节育器(IUD);B组(23例):术后放置Foley球囊导尿管,同时注入透明质酸钠凝胶,3 d后再次注入透明质酸钠凝胶并取出球囊,宫内放置IUD。在术后第1、2个月月经干净后3~5 d内,再次取环并放置球囊导尿管,3 d后取出重新放置IUD;C组(23例):术后放置氧化再生防粘连膜(interceed)+IUD。术后3个月,均行二次宫腔镜探查,评估治疗效果。结果 B组治疗总有效率87%(20/23),C组治疗总有效率96%(22/23),均明显高于A组(62%,21/34),差异有统计学意义(P0.05);C组的总有效率高于B组,但两组比较差异无统计学意义(P0.05)。结论 TCRA术后放置球囊导尿管或防粘连膜均可有效预防重度宫腔粘连术后复发。     

宫腔粘连术后应用三腔导管负压冲洗引流装置的临床疗效观察

目的:探讨宫腔三腔导管负压冲洗引流装置在宫腔镜下宫腔粘连分离术(TCRA)后的应用效果。方法:选择收集2017年8月至2018年8月在郑州大学第三附属医院就诊并经宫腔镜检查确诊为中、重度宫腔粘连,近期有生育要求并愿意治疗和随访的患者60例,随机数字法分为两组:A组30例,术后放置宫腔三腔导管负压冲洗引流装置治疗;B组30例术后放置二腔球囊导管治疗。观察时间为术后6个月。比较两组患者术后再粘连率、内膜恢复情况、月经评分及妊娠率。结果:在二次宫腔镜探查时A组有效率为93.3%,B组为83.4%,差异均有统计学意义(P<0.05);再粘连率分别为6.7%及16.7%。术后6个月A组内膜厚度及术后经量评分中位数值均高于B组,差异有统计学意义(P<0.05);术后6个月两组妊娠率差异无统计学意义(P>0.05);两组阴道总引流液量差异有统计学意义(P<0.05),而宫腔感染率、脱管率差异无统计学意义(P>0.05)。结论:宫腔镜下宫腔粘连分离术后应用宫腔三腔导管负压冲洗引流装置相比普通二腔球囊,可降低患者再粘连率,增加患者子宫内膜厚度,改善月经情况。     

中重度宫腔粘连术后放置COOK球囊和宫内节育器的疗效分析

目的:探讨中重度宫腔粘连(IUA)患者行宫腔镜下粘连分解术后放置COOK球囊及宫内节育器(IUD)后的月经改善、预防粘连复发及生育方面的疗效。方法:选取142例中重度宫腔粘连患者,随机分为COOK球囊组(65例)和IUD组(77例)。COOK球囊组:宫腔粘连分解术后放置COOK球囊,术后1周取出COOK球囊,术后1月再次行宫腔镜下探查术;IUD组:宫腔粘连分解术后放置元宫型IUD,术后1月取出并行宫腔镜下探查术。术后随访两组患者的粘连复发、月经改善及妊娠率。结果:COOK球囊组和IUD组的粘连复发率分别为12.3%(8/65)和27.3%(21/77),月经有效率分别为84.6%(55/65)和70.1%(54/77),两组比较差异均有统计学意义(P=0.036,P=0.048)。COOK球囊组和IUD组的术后妊娠率分别为61.5%(40/65)和53.2%(41/77),差异均无统计学意义(P=0.395)。结论:中重度IUA患者在宫腔镜粘连分解术后,放置COOK球囊比元宫型IUD能更有效地预防粘连复发和改善月经,术后妊娠率无明显差别。     

生物羊膜在中重度宫腔粘连分离术后的应用价值

目的:探讨生物羊膜在预防宫腔镜宫腔粘连分离术后(TCRA)再次粘连的临床效果。方法:选择2019年1～12月在我院就诊并经宫腔镜诊断为中重度宫腔粘连(IUA)患者61例作为研究对象,其中研究组31例,对照组30例。两组均采用TCRA,研究组术后放置生物羊膜+宫腔支架球囊,对照组术后放置宫形宫内节育器(IUD)+宫腔支架球囊。两组术后均口服雌激素促进子宫内膜生长,术后3个月复查宫腔镜,比较两组患者手术治疗效果及术后1年妊娠率。结果:两组术后月经改善情况、IUA评分、子宫内膜厚度、宫腔恢复情况及宫腔深度的增加,差异均有统计学意义(P<0.05)。两组术后1年的妊娠情况,差异无统计学意义(P>0.05)。结论:生物羊膜较目前临床上广泛使用的IUD联合宫腔支架球囊的方法更有助于TCRA后宫腔形态的恢复及子宫内膜的生长,但是对于其远期患者受益情况,还有待进一步大样本、多中心的实验研究考证。     

干细胞在宫腔粘连治疗中的研究进展

宫腔粘连（intrauterine adhesions， IUA）是一种常见的子宫内膜损伤性疾病。随着频繁的宫腔操作及宫腔镜手术的普及，IUA的发病率和检出率逐年升高，已成为女性继发不孕的第二大病因。目前针对IUA的治疗，轻中度患者通过传统治疗方法尚能取得一定疗效，但对于重度或广泛内膜损伤的患者，子宫内膜再生和功能恢复已成为妇产科医生临床上棘手的问题。随着干细胞在再生医学领域的广泛研究，国内外学者相继证实子宫内膜干细胞的存在，为IUA的治疗提供了新思路。综述干细胞在IUA治疗中的研究进展。     

Synéchie complexe récidivante : chirurgie itérative ?

Recurrence of intrauterine adhesions is high even though a correct hysteroscopic treatment is performed. So, primary and secondary means to prevent intrauterine adhesions is important. Patient information is a key point on the obstetrical prognosis of this disease.     

The Effect of Adjuvant Treatment to Prevent and Treat Intrauterine Adhesions: A Network Meta-Analysis of Randomized Controlled Trials

Intrauterine adhesions (IUAs) can lead to partial or complete closure of the uterine cavity, which may result in symptoms including abnormal menstruation, infertility, and pelvic pain. A network meta-analysis was performed to assess the effect of adjuvant therapy on the prevention and treatment of IUAs. We searched electronic databases, including PubMed, Embase, and the Cochrane Library, up to May 5, 2017, without language restrictions. The primary outcomes in the present analysis were the rate of IUAs for prevention and the rate of IUA recurrence for treatment. The secondary outcomes included the IUA score and the rate of severity of IUAs. The treatments were then ranked by the surface under the cumulative ranking curve (SUCRA). We included 20 articles that involved a total of 1891 patients in our analysis. In the outcomes of prevention-related studies, an alginate hyaluronate–carboxymethylcellulose membrane (ACH) (n?=?10, SUCRA score?=?93.3%) was the adjuvant treatment that most effectively reduced IUA incidence. It was followed by intercoat (n?=?10, SUCRA score?=?74.7%) and misoprostol (n?=?10, SUCRA score?=?68.6%). In addition, auto–cross-linked hyaluronic acid (ACP) (n?=?3, SUCRA score?=?83.2%) and intercoat (n?=?3, SUCRA score?=?66.4%) each corresponded to a relatively high preventive effect against severe IUAs. In the treatment-related studies, ACP plus a balloon (n?=?4, SUCRA score?=?96.3%) and a freeze-dried amnion graft plus a balloon (n?=?4, SUCRA score?=?62.7%) most effectively reduced IUA recurrence and had a high probability of most effectively reducing IUA scores. Therefore, according to the prophylactic analysis, ACH and intercoat were most likely to prevent IUA development. In our analysis of agents used to prevent severe IUAs, we found that ACP and intercoat provided significant advantages and had high reliability. In our analysis of treatments, ACP plus a balloon and freeze-dried amniotic agents plus a balloon were most likely to reduce IUA recurrence and IUA scores after adhesiolysis.     

Efficacy of Estrogen Therapy in Patients With Intrauterine Adhesions: Systematic Review

Hysteroscopic adhesiolysis has become the preferred option for management of intrauterine adhesions (IUA). Use of estrogen as perioperative adjuvant therapy has been suggested for preventing recurrent adhesions. The primary objective of this article was to review the literature for evidence of the efficacy of estrogen therapy in the management of IUA. All eligible studies were identified using computerized databases (PubMed, Scopus. and Web of Science) from their earliest publication date to July 2013. Additional relevant articles were identified from citations in these publications. Twenty-six studies were identified that reported use of hormone therapy as ancillary treatment after adhesiolysis. Of these studies, 19 used at least one of the following methods: intrauterine device, Foley catheter, hyaluronic acid gel, or amnion graft, in addition to hormone therapy as ancillary treatment. In 7 studies, hormone therapy was used as a single ancillary treatment. In 2 studies, no adjunctive therapy was used after adhesiolysis. Meta-analysis could not be performed because of the differences in treatment methods in these articles. There was a wide range of reported menstrual and fertility outcomes. Better menstrual and fertility outcomes were associated with use of estrogen in combination with other methods of ancillary treatment. At present, hormone therapy, in particular estrogen therapy, is beneficial in patients with IUA, regardless of stage of adhesions. However, estrogen therapy needs to be combined with ancillary treatment to obtain maximal outcomes, in particular in patients with moderate to severe IUA.     

The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications

Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy. Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was made to lyse them. Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60% of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one (P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to determine the subsequent reproductive outcome revealed similar conception rates in both groups. Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery.     

Amnion graft as a possible source of stem cells for endometrial regeneration after lysis of severe intrauterine adhesions

BackgroundThe current traditional management of severe intrauterine adhesions (IUAs) is hysteroscopic adhesiolysis with application of either an intrauterine contraceptive device or a Foley catheter balloon with reported recurrence in up to 50% of cases. Recently, significant improvement with the use of amnion graft following hysteroscopic lysis of severe IUA was reported.CaseIn the present case, endometrial stromal cells (ESCs) were found within and on the surface of amniotic membrane two months after its grafting intrauterine which was confirmed with CD10 immunohistochemistry.ConclusionAmniotic membrane graft after hysteroscopic lysis of severe IUA, might act as a source of stem cells for endometrial regeneration; a role that will be of great value especially in severe IUAs. Further studies to confirm this finding are warranted.     

宫腔镜治疗宫腔粘连45例临床分析

目的:探讨宫腔镜诊治宫腔粘连的临床价值。方法:对2008年1月至2010年1月在我院行宫腔镜诊治手术的45例患者的临床资料进行回顾性分析。结果:术后恢复正常月经患者33例,占73.3%;在痛经的6例患者中,6例术后得到缓解或治愈。结论:宫腔镜是诊治宫腔粘连的首选方法,值得临床推广应用。     

Toll样受体4在宫腔粘连患者子宫内膜中的表达

目的:探讨Toll样受体4(TLR4)在宫腔粘连(IUAs)患者子宫内膜的表达。方法:选择2010年9月至2010年12月因IUAs在中南大学湘雅三医院行宫腔粘连分离术的患者75例。选择同期因不孕行宫腔镜检查且子宫内膜正常的非IUAs患者30例。术中获取子宫内膜,应用免疫组织化学方法检测TLR4在IUAs子宫内膜及非IUAs正常子宫内膜的表达。结果:(1)TLR4在IUAs子宫内膜、非IUAs正常子宫内膜中阳性表达率分别为97.3%、93.3%,两者比较差异有统计学意义(P<0.05),IUAs子宫内膜TLR4的阳性表达率高于非IUAs正常子宫内膜。(2)TLR4在重度、中度、轻度IUAs患者子宫内膜中的强阳性表达率分别为80%、40%、10%,两两比较均有统计学差异(P<0.05),TLR4的阳性表达随着粘连严重程度而增加。结论:TLR4表达强弱与粘连程度相关,随着粘连严重程度增加,TLR4表达逐渐增强,提示TLR4可能与宫腔粘连的发展有关。