Human Amnion as a Temporary Biologic Barrier after Hysteroscopic Lysis of Severe Intrauterine Adhesions: Pilot Study
Human Amnion as a Temporary Biologic Barrier after Hysteroscopic Lysis of Severe Intrauterine Adhesions: Pilot Study
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DOI：
10.1016/j.jmig.2010.03.019
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发表时间：
2010-09-01
影响因子：
4.1
通讯作者：
Abdallah, Al Said
中科院分区：
文献类型：
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作者：
Amer, Mohamed I.;Abd-El-Maeboud, Karim H. I.;Abdallah, Al Said
研究目的：评估宫腔镜松解严重宫腔粘连后新鲜和干燥羊膜移植物在减少其复发和促进子宫内膜再生方面的功效。设计：试点前瞻性随机比较研究（加拿大工作组分类 I）。地点：埃及开罗艾因沙姆斯医学院。患者：45 名严重宫腔粘连患者。主要症状是不孕症，伴或不伴月经失调，如闭经或月经过少。 干预措施：术前使用计算机生成的随机表将患者随机分为 3 组，每组 15 名患者。分配给任何组的资金都隐藏在一个不透明的信封中，在操作时打开。宫腔镜下宫腔粘连松解术后仅插入宫内球囊（第 1 组）或新鲜羊膜移植物（第 2 组）或干燥羊膜移植物（第 3 组），持续 2 周。术后 2 至 4 个月进行诊断性宫腔镜检查。测量和主要结果：确定粘连等级、月经、子宫长度、并发症和生殖结果。与单独使用宫内球囊相比，羊膜移植的粘连等级显着改善 (p = .003)。新鲜羊膜的改善比干羊膜的改善更大 (p = .01)。第1组有4名患者（28.6%），第2组有4名患者（28.6%），第2组有7名患者（46.7%），第3组有7名患者（46.7%）。43名患者中，41名（95.3%）接受了2次内镜治疗（95.3%），2名患者（4.7%）接受了3次内镜治疗。 2 名患者（4.7%）发生子宫穿孔，3 名患者（7.0%）发生宫颈撕裂。 10 名患者 (23.3%) 成功怀孕，其中 8 名 (80%) 接受羊膜移植后怀孕，2 名 (20%) 未接受羊膜移植。 10 名患者中有 6 名 (60%) 流产，4 名 (40%) 仍然怀孕或足月分娩，没有并发症。结论：宫腔镜下移植新鲜或干燥羊膜来松解严重宫腔粘连是减少粘连复发和促进子宫内膜再生的一种有前景的辅助手术。微创妇科杂志 (2010) 17, 605-611 (C) 2010 AAGL。版权所有。
Study Objective: To estimate the efficacy of fresh and dried amnion graft after hysteroscopic lysis of severe intrauterine adhesions in decreasing its recurrence and encouraging endometrial regeneration.Design: Pilot prospective randomized comparative study (Canadian Task Force classification I).Setting: Ain Shams Medical School, Cairo, Egypt.Patients: Forty-five patients with severe intrauterine adhesions. Primary symptom was infertility with or without menstrual disorders such as amenorrhea or hypomenorrhea.Interventions: Patients were randomized preoperatively using a computer-generated randomization sheet into 3 groups of 15 patients each. Allocation to any group was concealed in an opaque envelope, which was opened at the time of operation. Hysteroscopic lysis of intrauterine adhesions was followed by insertion of an intrauterine balloon only (group 1) or either fresh amnion graft (group 2) or dried amnion graft (group 3) for 2 weeks. Diagnostic hysteroscopy was performed at 2 to 4 months postoperatively.Measurements and Main Results: Adhesion grade, menstruation, uterine length, complications, and reproductive outcome were determined. There was significant improvement in adhesion grade with amnion graft vs intrauterine balloon alone (p = .003). Improvement was greater with fresh amnion than with dried amnion (p = .01). Normal menstruation occurred in 4 patients (28.6%) in group 1,5 (35.7%) in group 2, and 7 (46.7%) in group 3. Of 43 patients, 41(95.3%) were treated in 2 endoscopic sessions (95.3%), and 2 patients (4.7%) were treated in 3 endoscopic sessions. Uterine perforations occurred in 2 patients (4.7%), and cervical tears in 3 (7.0%). Ten patients (23.3%) achieved pregnancy, 8 (80%) after amnion graft and 2 (20%) without amnion. Six of the 10 patients (60%) miscarried, and 4 (40%) were either still pregnant or delivered at term without complications.Conclusion: Hysteroscopic lysis of severe intrauterine adhesions with grafting of either fresh or dried amnion is a promising adjunctive procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration. Journal of Minimally Invasive Gynecology (2010) 17, 605-611 (C) 2010 AAGL. All rights reserved.