.A novel intrauterine barrier for preventing the recurrence of IUA after TCRA procedure
.A novel intrauterine barrier for preventing the recurrence of IUA after TCRA procedure
复制标题
.一种新型宫内屏障，可预防 TCRA 手术后 IUA 复发
DOI：
10.1016/j.mehy.2022.110947
复制
发表时间：
2022
影响因子：
4.7
通讯作者：
Dan Liu
中科院分区：
文献类型：
--
作者：
Meixia Chen;Liwei Yuan;He Jin;Ngenzi Richard Djurist;Xueyu Zhang;Dan Liu
宫内粘连(IUA)是创伤和感染后子宫内膜修复异常的结果，损伤了子宫内膜的基底层，然后被疤痕组织取代。在这种情况下，子宫内膜会部分或完全丧失受孕能力。即使在以手术为基础的综合治疗之后，粘连率仍然很高。子宫内膜变薄、血液供应不足和功能不良也可能导致难治性不孕，即使宫腔完全恢复正常，也会导致不良的生殖预后。因此，术后处理的两个关键是使用宫内屏障以防止再粘连和使用药物促进子宫内膜修复。然而，目前还没有一种临床适用的屏障可以满足个性化尺寸的宫腔形状和大小或有效地分隔创面壁。我们设计了一种宫内屏障，它由一个独特的子宫形状、释放雌激素的宫内节育器(IUD)组成，它可以与可注射的温度敏感水凝胶相结合。在本研究中，我们将在经宫颈粘连切除术(TCRA)后将释放雌激素的宫内节育器(IUD)放置到宫腔内，同时通过宫颈通道向宫腔内注入3-5mL室温下的液体水凝胶。由于水凝胶的温度敏感性，水凝胶会逐渐固化成胶状的稠度，用固体屏障填充宫腔，完全防止与伤壁接触，避免粘连复发。释放雌激素的宫内节育器将被包裹在水凝胶屏障中，水凝胶屏障有许多毛孔，允许持续释放雌激素，以促进子宫内膜的再生和修复。该方案可以满足TCRA术后处理的需要，但其有效性尚需实验和临床研究证实。如果研究组患者的粘连复发率低于对照组，妊娠率高于对照组，我们的假设将被证实，这种屏障将被证明是一种临床应用，有助于子宫内膜的功能修复，实现良好的生殖预后。
Intrauterine adhesion (IUA) is the result of abnormal endometrium repair after trauma and infection that damages the basal layer of the endometrium, which is then replaced by scar tissue. In such instances, the endometrium partially or completely loses the ability to conceive the embryo. Even after surgery-based comprehensive treatment, a high rate of adhesion remains. A thin endometrium, poor blood supply, and poor function may also lead to refractory infertility, resulting in a poor reproductive prognosis even when the uterine cavity has been completely restored to normal. Therefore, two key points of postoperative management are the use of an intrauterine barrier to prevent re-adhesion and medicine to promote endometrial repair. However, there is currently no clinically applicable barrier that can meet the personalized dimensions of uterine cavity shape and size or effectively separate the wound wall. We have designed an intrauterine barrier that consists of a unique uterine-shaped, estrogen-release intrauterine device (IUD), which can be combined with an injectable, temperature-sensitive hydrogel. For this study, we will insert an estrogen-release IUD into the uterine cavity following transcervical resection of adhesion (TCRA) surgery, at the same time injecting 3–5 mL of liquid hydrogel at room temperature into the uterine cavity via the cervical channel. Due to its temperature sensitivity, the hydrogel will gradually solidify into a jellylike consistency, filling the uterine cavity with a solid barrier and completely preventing contact with the wounded wall to avoid the recurrence of adhesion. The estrogen-release IUD will be wrapped in the hydrogel barrier, which has many pores that allow sustainable estrogen release to promote endometrial regeneration and repair. This protocol can meet the needs of postoperative management of TCRA, but experimental and clinical studies are still needed to demonstrate its effectiveness. If patients in the study group have a lower adhesion recurrence and higher pregnancy rate compared to controls, our hypothesis will be confirmed that this barrier will prove a clinical application to help the functional repair of the endometrium and achieve a good reproductive prognosis.