宫腔手术后预防宫腔粘连的研究现状

宫腔粘连(intrauterine adhesion,IUA)是宫腔手术后常见并发症,是导致子宫性不孕的主要原因.对于IUA最重要的是进行预防,术后口服避孕药及宫内节育器的置入在临床上应用广泛,同时具有避孕的作用.使用球囊导尿管需住院治疗,且术后应用广谱抗生素预防上行感染.防粘连产品的应用需考虑患者经济因素.羊膜移植的...     

宫腔粘连研究进展

宫腔粘连（intrauterine adhesions,IUA）在临床上主要表现为闭经、月经过少、经期下腹痛、不孕等严重影响广大妇女的日常生活。IUA的治疗原则主要为手术分离粘连,术后辅助治疗促进子宫内膜的修复,而IUA术后预防再复发是IUA治疗中的重中之重,目前IUA分离术后再粘连的预防越来越得到学者们的关注。现将IUA的病因、诊治方法、治疗特别是预防IUA分离术后再粘连的方法的最新研究进展做一综述,以期指导临床。     

宫腔粘连分离术后预防再次粘连的研究进展

宫腔粘连(IUA)是因各种宫腔操作引起的子宫内膜损伤性疾病,亦称为Asherman综合征。近年,IUA发生率呈不断增长的趋势。随着宫腔镜技术的持续发展,宫腔镜下粘连分离术(TCRA)取得了一定的疗效。粘连易复发,因此术后粘连的预防尤为关键。本文较全面地总结IUA术后预防再次粘连的各种方法,为临床预防术后粘连的相关治疗提供依据。     

羊膜移植预防宫腔粘连分离术后再粘连的临床研究

目的:探讨羊膜移植预防宫腔镜下宫腔粘连(IUA)分离术后再粘连的临床效果。方法:选择2016年1月至2019年7月在中国医科大学附属盛京医院行宫腔镜检查并诊断为中、重度IUA的131例患者。依据术后预防宫腔再粘连方法分为羊膜球囊组(30例)、球囊组(46例)和宫内置环组(55例),比较宫腔镜下IUA分离术术后3种不同方法预防宫腔再粘连的临床效果。结果:羊膜球囊组在术后月经改善情况及宫腔恢复情况方面疗效明显优于球囊组和宫内置环组(P0.05),后两组比较差异无统计学意义(P0.05)。结论:羊膜移植结合传统球囊扩张方法预防宫腔镜下IUA分离术术后宫腔再粘连效果更佳,能明显减少再粘连的发生,更好地维持术后宫腔形态,改善月经情况,提高患者的生活质量,值得临床应用与推广。     

羊膜对下调宫腔创伤微环境中解离素-金属蛋白酶家族成员ADAM15、17表达的作用

目的:探讨宫腔粘连(IUA)电切术后应用羊膜对宫腔创伤愈合微环境中的解离素-金属蛋白酶(ADAM)15、17表达的影响,从分子生物学角度评价羊膜预防宫腔再粘连的有效性。方法:选取2010年1月至2012年10月在宁夏医科大学总医院、宁夏医科大学心脑血管病医院经宫腔镜检查确诊为中重度IUA且行宫腔镜下宫腔粘连电切术后应用羊膜球囊者26例。根据粘连程度分为IUA-II(16例)和IUA-III(10例)。Western blot和Real-time PCR法分别检测ADAM15、17的蛋白及mRNA表达水平。比较术中粘连组织及术后1月同部位子宫内膜组织中的ADAM15、17表达水平。结果:1例重度宫腔粘连患者术后失访。羊膜应用1月后,宫腔组织中ADAM15、ADAM17蛋白和mRNA表达均下调(P0.01)。结论:宫腔粘连电切术后应用羊膜,可降低宫腔创伤微环境中与IUA形成有关的ADAM15和ADAM17的表达,从分子生物学角度评价羊膜应用预防IUA有效。     

宫腔粘连分离术后预防再粘连的临床研究

<正>宫腔粘连(intrauterine adhesion,IUA)主要是由刮宫和感染引起的,临床主要表现为闭经或月经过少、周期性腹痛等。宫腔镜下行IUA分离术(transcervical resection of adhesions,TCRA)是在直视下有针对性地分离或切除IUA,是患者恢复正常月经、改善妊娠及分娩结局的标准方法,但术后可能发生宫腔再次粘连。2009年1月至2012年6月我院采用两种不同的治疗方法预防宫腔再次粘连,以探讨有效的预防方法。1资料与方法1.1一般资料选取上述期间江苏大学附属宜兴医院宫腔     

宫腔粘连术后再粘连预防的研究进展

<正>宫腔粘连(intrauterine adhesions,IUA)是指子宫内膜基底层损伤后修复障碍所致的宫腔部分或全部粘连闭塞。IUA常引起月经过少、闭经、不孕及反复流产等生殖问题,严重影响了无数育龄女性的生育能力、生活质量甚至家庭和谐。目前,宫腔镜下粘连分离术作为治疗IUA的标准术式,可以即时恢复宫腔解剖学形态及改善IUA相关症状。然而,术后宫腔再粘     

雌激素在宫腔粘连中的应用及机制探讨

宫腔粘连(IUA)对女性的身体及心理造成不同程度的伤害。宫腔镜手术能恢复宫腔正常形态,但不能修复子宫内膜,从而造成再粘连的发生。有研究显示,行宫腔镜宫腔粘连分离的患者术后再粘连的发生率为3.1%~23.5%。雌激素能促进内膜腺体和间质细胞的增殖,促进内膜血管的生成,从而达到尽快修复创面、形成子宫壁的功能性分离,有利于新生内膜的生长。因此,IUA术后多应用雌激素预防再粘连发生,但目前关于雌激素的用法、用量并不十分统一,有待于进一步的深入研究。     

宫腔粘连分离术后预防粘连复发的方法及研究进展

宫腔粘连(intrauterine adhesions,IUA)是指由于多种因素导致子宫内膜基底层受损,临床症状主要表现为月经异常、不孕、复发性流产及早产、胎盘异常等产科相关并发症.宫腔镜手术是治疗IUA的标准术式,但是中、重度IUA患者术后的复发率较高,严重影响患者的生殖预后.目前临床上预防术后粘连复发的方法包括雌激...     

宫腔镜诊治宫腔粘连的评价

宫腔粘连(intrauterineadhesion,IUA)又称阿谢曼综合征(Ashermansyndrome),由Asherman1948年首报。IUA是宫腔普通手术后的远期并发症,也是宫腔镜电切术后的远期主要严重并发症。1IUA的发病率根据1983年北京与天津三所医院资料统计,人工流产术后宫腔粘连发生率0.1%～0.41%。南京鼓楼医院10年(1984～1993年)资料统计,人工流产术与刮宫术后发生率0.25%。同期宫腔镜检查术1485例,其中IUA135例,检出率9.1%。近5年(2000～2004)宫腔镜检查术1640例,其中IUA155例,检出率9.5%。近年文献报道,IUA发病率有逐年上升趋势。2000年,Taskin报道95例…     

Intrauterine candidiasis: report of four cases

BACKGROUND: Despite the high incidence of candida vaginitis, intraamniotic candida infection seems to be a rare disease. This infective agent can cause chorioamnionitis even in the presence of intact fetal membranes. METHODS AND RESULTS: We report four new cases of intrauterine candidiasis and describe the associated clinicopathological features. Three of the cases had predisposing risk factors, like rupture of membranes or intrauterine contraceptive device, and ended in fetal death; the fourth case had a gestational trophoblastic disease. DISCUSSION: The pathogenic significance of fetal contamination by candida appears to depend largely on gestational age. Candida infection of the fetus can result in prematurity and death. The importance of early and accurate diagnosis of intraamniotic infection with candida is emphasized.     

宫腔粘连的预防方法研究进展

宫腔粘连是导致不孕症的妇科常见病之一,严重危害育龄期女性生育功能及心理健康,妊娠期宫腔操作是主要原因。其发病率随宫腔操作机会增加而升高。宫腔镜检查是诊断金标准,宫腔镜下宫腔粘连分离术（transcervical resection of uterine adhesions,TCRA）是治疗的标准术式,轻度宫腔粘连治疗效果好,但中、重度宫腔粘连治疗效果欠佳,复发率高。预防宫腔粘连的方法众多,有预防性使用抗生素、口服雌激素、宫腔内注入透明质酸钠、放置宫内节育器或球囊支架等,现尚无统一标准。宫腔粘连治疗多采用TCRA+防粘连材料+人工周期的综合治疗方案,效果较单纯宫腔镜下宫腔粘连分离术好。     

Intrauterine contraception: from silver ring to intrauterine contraceptive implant

Gräfenberg introduced his silver ring in 1928 and by his classic paper, published in 1931, provided intrauterine contraception with a scientific basis. For largely non-medical reasons, the Gräfenberg ring vanished from the scene a few years later, and it took almost 30 years before the method was rehabilitated as a result of a change in mental attitude toward birth control, the awareness of world population explosion, and the introduction of improved intrauterine devices (IUDs). The United States became the epicenter of IUD research in the 1960s but, due to adverse publicity and the threat of litigation, the pendulum swung and European investigators took over the job of improving the IUD. Proceeding from Dr Gräfenberg’s classic paper, the major steps in the evolution of the intrauterine devices are retraced with focus on the scientists who were innovative in the field.     

宫腔粘连分离术后复发为重度宫腔粘连的因素分析

目的:探讨宫腔粘连(IUA)分离术后再次发生IUA且成重度粘连的危险因素。方法:前瞻性建立IUA复发患者的临床队列,根据美国生殖学会IUA评分标准分为非重度组和重度组,首先逐一分析可能相关的因素,然后对有统计学意义的因素进行多因素非条件Logistic回归分析。结果:2015年1月至2016年6月共295例复发性IUA患者参加研究。多因素分析发现初次发现IUA时为重度、刮宫后闭经史、多次IUA分离手术史者复发成重度粘连的风险明显增高,其OR值分别为12.12(95%CI 5.30~27.7),3.24(95%CI 1.60~6.57),1.69(95%CI 1.11~2.58)。结论:初次发现IUA时为重度或有刮宫后闭经史的患者行IUA分离手术后易复发为重度粘连;多次IUA分离也是IUA复发并成重度粘连的危险因素。     

胚胎宫内生长受限临床分析-附2例报告

目的总结和探讨孕早期胚胎宫内生长受限的临床过程和处理方法.方法对2例孕早期胚胎宫内生长受限的临床资料进行分析.结果宫内生长受限的胚胎给予治疗后能继续正常生长.结论孕早期存在胚胎宫内生长受限的现象.     

宫腔粘连病因学及治疗研究进展

宫腔粘连是影响女性生殖健康的一个重要因素,随着医学的发展,其病因学的研究不断深入,流行病学调查、临床观察研究等方法揭示了宫腔粘连的高危因素为:妊娠后清宫术、剖宫产术后、滋养细胞疾病清宫术、苗勒管畸形、生殖道结核感染、诊断性刮宫、经腹子宫肌瘤剔除术、子宫动脉栓塞、宫腔镜手术、放置宫内节育器、产后出血子宫压迫性缝合等,这为其预防及治疗提供了思路。而医学工作者不断创新宫腔粘连治疗方法,从手术治疗、预防粘连再次发生、促子宫内膜再生治疗、术后再次评估治疗效果四方面进行科学研究,探寻治疗宫腔粘连的最优策略。利用干细胞移植技术治疗重度宫腔粘连并成功妊娠的病例报道,为宫腔粘连的治疗开辟了新思路。     

Intrauterine fetal death

Sadly, intrauterine fetal death is a common occurrence and one that all labour ward personnel should be trained to manage. Recent advances have improved the likelihood of identifying a cause. The key to this is a logical and methodical approach to investigation. Postmortem examination remains a critical aspect of investigation and labour ward teams require a clear understanding of the legal aspects of this. Sympathetic and supportive care of parents should respect parental wishes and allow choice wherever possible. However, maternal safety should also be a central aspect of this care.     

Markers for Presymptomatic Prediction of Preeclampsia and Intrauterine Growth Restriction

Preeclampsia and intrauterine growth restriction are both characterized by placental malfunction. The pathological processes of abnormal trophoblast invasion, partial absence of maternal spiral artery modification, increased apoptosis of trophoblast cells, and placental ischemia are all associated with the release of specific molecules. These proteins, as well as cell‐free fetal DNA and RNA might be detected in the maternal peripheral circulation, quantified, and used for early identification and prediction of preeclampsia and intrauterine growth restriction, prior to the appearance of the clinical symptoms. As preeclampsia and intrauterine growth restriction are associated with increased maternal, perinatal, and neonatal morbidity and mortality, early identification of these pregnancy associated complications will permit the design of appropriate preventive measures. In this review a variety of factors reported to be useful as potential markers for early detection of pregnancies at increased risk will be discussed. Molecules associated with the establishment of the placenta and essential in fetal–maternal interactions, like interleukin 2‐receptor, insulinlike growth factor‐1, and insulinlike growth factor binding protein‐1, placenta growth factor, hepatocyte growth factor, inhibin A, activin A, and human chorionic gonadotrophin seem to be the most likely candidates for presymptomatic markers for preeclampsia and/or intrauterine growth restriction. Detection and discrimination of these molecules through the placental RNA in maternal plasma based strategy has become a realistic option.     

Temporary Resolution of Preeclamptic Symptoms After Intrauterine Death of One Twin

In a 34 year old woman with dichorionic twin pregnancy preeclampsia resolved after the intrauterine death of one of the HLA-identical twins and recurred with the growth of the placenta of the surviving twin later in pregnancy. This case gives indirect evidence that the clinical course of preeclampsia is a dose-dependent phenomenon in conjunction with vital placental tissue.     

Intrauterine treatment of a fetal pulmonary cyst by chorioamniotic shunt

Summary This is a report of a prenatal diagnosis and successful intrauterine drainage of a pulmonary cyst by placement of a thoracoamniotic shunt at 36 weeks gestation. At the time of delivery the newborn had no signs of pulmonary hypoplasia or respiratory insufficieny.