The study on the safety and efficacy of amnion graft for preventing the recurrence of moderate to severe intrauterine adhesions
The study on the safety and efficacy of amnion graft for preventing the recurrence of moderate to severe intrauterine adhesions
复制标题
DOI：
10.1016/j.gendis.2019.03.003
复制
发表时间：
2020-06-01
期刊：
影响因子：
6.8
通讯作者：
Wang, Jia
中科院分区：
文献类型：
--
作者：
Li, Changjiang;Cai, Aiqi;Wang, Jia
宫颈粘连切除术(TCRA)是治疗宫腔粘连的标准方法，但粘连复发是困扰妇科医生的一大难题。此外，TCRA术后预防复发的治疗策略仍然存在争议，尤其是对于中到重度宫内粘连(IUA)的患者。因此，本研究旨在探讨新鲜羊膜移植预防中重度宫内窘迫综合征患者TCRA术后复发的安全性和有效性。从2015年1月到2017年12月，100名有月经过少、闭经和不孕症病史的中重度宫内节育器患者被纳入研究。随机分为羊膜组(52例)和壳聚糖组(48例)。TCRA术后行新鲜羊膜移植或宫内注射几丁糖。术后1个月和3个月分别行经阴道超声(TVUS)和宫腔镜检查。所有患者均顺利完成手术，无相关并发症发生。羊膜组术后1个月复发8例，3个月复发2例，壳聚糖组术后1个月复发23例，3个月复发18例。经统计学处理，羊膜组术后1个月、3个月粘连复发率明显低于壳聚糖组(P-1=0.000，P-2=0.000)。TCRA术后，新鲜羊膜移植物在防止进一步粘连方面的作用明显优于壳聚糖注射。版权所有(C)2019，重庆医科大学。爱思唯尔B.V.制作和主办。
Transcervical resection of adhesion (TCRA) is the standard treatment for the intrauterine adhesions, but the recurrence of adhesions is a tough problem for the gynecologist. In addition, the therapeutic strategy after TCRA about prevention of recurrence remains controversial especially for the patients with moderate to severe intrauterine adhesions (IUAs). Hence, we designed this study to explore the safety and efficacy of fresh amnion grafts for preventing the recurrence after TCRA for patients with moderate to severe IUAs. One hundred patients with moderate to severe IUAs who presented with a history of hypomenorrhea, amenorrhea and infertility were included in the study from January 2015 to December 2017. Patients were divided into amnion group (52 patients) and chitosan group (48 patients). Fresh amnion grafts or intrauterine injections of chitosan were administered after TCRA. Transvaginal ultrasonography (TVUS) and hysteroscopy were performed at the first and third month after the operation. The surgical procedures for all patients were completed successfully without relevant complications. In amnion group, 8 patients exhibited relapse in the first month and 2 patients in three months after surgery; in chitosan group, 23 women exhibited relapse in the first month and 18 patients in three months after surgery. Statistical analysis revealed that the recurrence rate of adhesion in amnion group was significantly lower than those of chitosan group in the first and three months after surgery (P-1 = 0.000, P-2 = 0.000). After TCRA, fresh amnion graft plays a significant role in preventing further adhesions than injections of chitosan. Copyright (C) 2019, Chongqing Medical University. Production and hosting by Elsevier B.V.