羊膜宫腔内植入+人工周期治疗中、重度宫腔粘连的安全性及有效性

目的:评价人羊膜在宫腔粘连松解术(TCRA)后置入宫腔的安全性及预付再粘连的有效性。方法:回顾性分析34例宫腔中、重度粘连的不孕患者宫腔粘连松解术后宫腔内放置表面被覆羊膜的Foley’s球囊,1周后取出,同时给予雌激素/黄体酮周期治疗。术后第1、3个月宫腔镜检查。随访观察粘连复发率,月经改善和妊娠结局。结果:12例中度粘连组(A组)和22例重度粘连组(B组)患者手术均顺利且无并发症发生,围手术期均无感染症状。A组中75%的患者和B组中45.5%的患者月经恢复正常或得到明显改善。A组无一例宫腔粘连复发,B组中11例复发。所有患者宫内妊娠率为35.3%(12/34)。结论:人羊膜+雌激素/黄体酮周期治疗安全、有效,并能预防宫腔再次粘连的有效方法。

Safety and Efficacy of Amnion Graft Combined with Artificial Cycle on Uterine Adhesion

Objective: To evaluate the safety and efficacy of amnion grafting and artificial cycle after hysteroscopic lysis of intrauterine adhesions.Methods: A retrospective study involving 34 patients with moderate or severe intrauterine adhesions was performed.All patients received hysteroscopic adhesiolysis which was followed by intrauterine application of a fresh amnion graft over an inflated balloon of a Foley’s catheter for 7 d,and were treated with artificial cycle.Follow-up hysteroscopy was performed after 1 and 3 months of operation(trans-cervical resection of uterine adhesion,TCRA).Outcome measures included achievement of normal menstrual flow,recurrence of adhesions and pregnancy rate.Results: Moderate(group A) and severe(group B) adhesions were found in 12 and 22 subjects,respectively.No operative complications occured.No clinical evidence of infection was observed.Significant achievement of menstrual flow was found in 100% in group A versus 86.4% in group B.Follow-up hysteroscopy revealed adhesion reformation rate was 50%,all belonging to group B.Pregnancy rate of all patients was 35.3%(12/34).Conclusion: Hysteroscopic lysis of intrauterine adhesions with amnion grafting combined with artificial cycle seems to be a promising procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration.