宫腔粘连分离术后预防复发和改善生殖结局的辅助治疗措施

宫腔镜下宫腔粘连分离术是治疗宫腔粘连的最常用方法,但术后粘连复发率高,妊娠结局不理想,因此术后常需联合辅助治疗措施改善预后。传统辅助治疗措施主要包括物理屏障以及口服或局部应用药物等,其中宫内放置Foley导管常与口服雌激素联合应用,因其疗效稳定、性价比高等优点在临床上应用已久。近年来以生物制剂和生物材料为基础的多种新型辅助治疗措施逐渐应用于宫腔粘连分离术后,其中富血小板血浆和干细胞等生物制剂在促进子宫内膜修复、改善生殖结局等方面显示出了更好的治疗效果。此外,基于凝胶、支架等生物材料的新型辅助治疗措施也显示出了良好的治疗作用,为难治性宫腔粘连带来了希望。综述宫腔粘连分离术后传统及新型辅助治疗措施的研究进展,为宫腔粘连的综合治疗提供新的临床思路。

Postoperative Adjuvant Measures for Preventing Adhesion Recurrence and Improving the Reproductive Outcome after Hysteroscopic Adhsiolysis

Hysteroscopic adhesiolysis is the universal treatment for intrauterine adhesion. However the adhesion recurrence rate is high, and the reproductive outcome is not satisfied. Therefore, postoperative adjuvant measures are commonly used to improve the prognosis. Traditional adjuvant measures mainly include physical barriers, oral and topical medications, etc. Foley catheter is often combined with oral estrogen therapy to improve the prognosis, which has been widely used in clinical practice for decades due to its advantages of stable therapeutic effect and cost-effective. In recent years, a variety of novel adjuvant measures based on biologicals and biomaterials have been used in the comprehensive treatment of intrauterine adhesion. Among biologicals, platelet-rich plasma and stem cells have shown better therapeutic effects of advancing endometrial repair and improving reproductive outcomes. In addition, some novel adjuvant measures based on biological materials such as gels and scaffolds have also shown good therapeutic effects, which brings a hope to refractory intrauterine adhesion. We review the research progress of traditional and novel adjuvant measures to prevent the recurrence of intrauterine adhesion, and to improve reproductive outcome after operation. This review also provides some clinical insights for the comprehensive treatment of intrauterine adhesion.