生物羊膜制品置入改善宫腔粘连术后子宫内膜容受性分析

目的　探讨生物羊膜制品用于宫腔镜下宫腔粘连分离术（transcervical resection of adhesions，TCRA）的子宫内膜容受性。 方法　回顾性分析2019年11月至2020年11月本院妇产科收治并经宫腔镜检查确诊为中、重度宫腔粘连患者64例。按TCRA术后预防再粘连的方法分为实验组（术后注入几丁糖并放置生物羊膜制品）和对照组（术后注入几丁糖），各32例。使用2015年中国宫腔粘连分级评分标准诊断宫腔粘连程度。所有患者术后给予雌孕激素人工周期治疗2月，术后3月行宫腔镜复查。比较两组患者术后再粘连率以及子宫内膜厚度、子宫动脉阻力参数、妊娠结局等。 结果　术后1个月实验组和对照组子宫内膜厚度分别为（5.89±0.84）mm和（4.37±0.52）mm，差异有统计学意义（t＝8.689，P<0.01）；术后2个月实验组子宫内膜厚度为（8.38±0.84）mm，对照组（7.17±1.00）mm，差异有统计学意义（t＝5.215，P<0.01）。宫腔镜复查，实验组再粘连率为6.25%，对照组为18.75%，差异有统计学意义（P<0.05）。两组子宫动脉血流参数以及妊娠率等比较均有统计学差异（P<0.05）。 结论　在中、重度宫腔粘连分离术后置入生物羊膜制品，可以增加子宫内膜厚度，改善子宫血液循环，从而改善子宫内膜容受性，提高妊娠率。因此，置入生物羊膜制品可以作为临床治疗宫腔粘连有效可行的新辅助治疗手段。

Analysis of endometrial receptivity after implantation of biological amniotic products to improve intrauterine adhesions

Objective　To investigate the endometrial receptivity of biological amniotic products after hysteroscopic intrauterine adhesion separation (TCRA). Methods A retrospective analysis for clinical data of 64 cases of women who received TCRA because of medium or heavy IUA in the Affiliated Hospital of Medical School, Ningbo University from November 2019 to November 2020 was performed. The 64 cases were divided into the following two groups according to the method of TCRA postoperative readhesion prevention: an experimental group (biological amniotic products were placed after TCRA with chitosan), and a control group (chitosan was placed after TCRA). Each group was 32 cases. The Chinese Intrauterine Adhesion Grating and Scoring Standard proposed by Chinese Clinical Diagnostics Experts of Intrauterine Adhesion in 2015 was used to diagnose the degree of intrauterine adhesions. All patients received artificial cycle treatment of estrogen progesterone for 2 months. The endometrial thickness, uterine artery resistance parameters and pregnancy rate were compared between the two groups. Results One month after operation, the endometrial thickness of the experimental group and the control group were (5.89±0.84) mm and (4.37± 0.52) mm, respectively, the differences were statistically significant (T=8.689,P<0.01). Two months after operation, the endometrial thickness of the experimental group and the control group were (8.38±0.84) mm, (7.17±1.00) mm, the differences were statistically significant (t＝5.215, P<0.01). At the second hysteroscopy, the readhesion rate of the experimental group was 6.25%, and that of the control group was 18.75%, with statistical significance (P<0.05). There were statistical differences in the arterial blood flow parameters and pregnancy rate between the two groups. Conclusions The implantation of biological amniotic membrane products after the separation of moderate or severe intrauterine adhesions can increase the thickness of the endometrium and improve the blood circulation of the uterus and the receptivity of the endometrium, ultimately increase the pregnancy rate. Therefore, the implantation of biological amniotic membrane products can be an effective and feasible neoadjuvant treatment for clinical treatment of intrauterine adhesions.