国际妇产科学杂志

国际妇产科学杂志 ›› 2024, Vol. 51 ›› Issue (1): 110-113.doi: 10.12280/gjfckx.20230717

• 普通妇科疾病及相关研究:论著 • 上一篇    下一篇

自交联透明质酸钠凝胶预防轻中度宫腔粘连术后复发疗效及生殖结局

郭艳, 夏恩兰, 肖豫, 黄晓武, 刘玉环, 杨玲玲(), 李天照   

  1. 100038 北京，首都医科大学附属复兴医院宫腔镜诊治中心
  • 收稿日期:2023-09-12 出版日期:2024-02-15 发布日期:2024-02-19
  • 通讯作者: 杨玲玲 E-mail:yangling09@126.com

The Efficacy and Reproductive Outcome of Auto-Cross-Linked Hyaluronic Acid Gel for the Prevention of Recurrence of Mild to Moderate Intrauterine Adhesions

GUO Yan, XIA En-lan, XIAO Yu, HUANG Xiao-wu, LIU Yu-huan, YANG Ling-ling(), LI Tian-zhao   

  1. Hysteroscopy Center, Fuxing Hospital of Capital Medical University, Beijing 100038, China
  • Received:2023-09-12 Published:2024-02-15 Online:2024-02-19
  • Contact: YANG Ling-ling E-mail:yangling09@126.com

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摘要：

目的：研究自交联透明质酸钠（auto-cross-linked hyaluronic acid，ACP）凝胶预防轻中度宫腔粘连（intrauterine adhesion，IUA）患者经宫腔镜宫腔粘连松解术（transcervical resection adhesion，TCRA）后粘连复发的疗效及对生殖结局的影响。方法：收集2020年5月—2021年3月在首都医科大学附属复兴医院（我院）行TCRA的188例轻中度IUA患者，单中心前瞻随机对照观察术后IUA复发率、美国生育协会（American Fertility Association，AFS）评分、月经改善情况及生殖结局，分析ACP凝胶预防IUA复发的疗效及生殖结局。研究组（84例）TCRA术终宫腔注入ACP凝胶+球囊支架，对照组（87例）TCRA术终仅宫腔放置球囊支架。结果：171例患者术后4周和8周分别进行宫腔镜第2次探查和第3次探查，研究组IUA复发率稍低于对照组，但差异无统计学意义（20.2% vs. 23.0%，9.5% vs. 11.5%，均P>0.05）。两次宫腔镜复查2组患者AFS评分比较，差异无统计学意义（P>0.05）。术后12周，2组患者月经改善情况比较差异无统计学意义（P=0.630）。TCRA术后1年余，2组患者妊娠率和活产率比较差异无统计学意义（均P>0.05）。结论：在轻中度IUA患者中，与TCRA术后单纯使用球囊相比，术后球囊联合宫腔内注入ACP凝胶并不能降低IUA复发率及粘连严重程度，也不能促进月经模式及术后生殖结局改善。

关键词: 宫腔镜, 透明质酸, 凝胶类, 复发, 月经失调, 妊娠结局, 宫腔粘连

Abstract:

Objective: To investigate the efficacy of auto-cross-linked hyaluronic acid (ACP) gel in preventing adhesion recurrence after transcervical resection adhesion (TCRA) in patients with mild to moderate intrauterine adhesion (IUA) and its effect on reproductive outcomes. Methods: 188 patients with mild to moderate IUA who underwent TCRA in Fuxing Hospital of Capital Medical University from May 2020 to March 2021 were collected, and the recurrence rate of postoperative IUA, American Fertility Association (AFS) score, menstrual improvement and reproductive outcomes were observed in a single-center prospective randomized controlled manner, and the efficacy of ACP gel in preventing recurrence of IUA and its effect on reproductive outcomes were analyzed. The study group (84 cases) was received intrauterine injection of ACP gel + balloon stent at the end of surgery, and the control group (87 cases) only received balloon stent at the end of surgery. Results: 171 cases underwent the second and third hysteroscopies at 4 and 8 weeks after surgery, respectively. The recurrence rate of IUA in the study group was slightly lower than that in the control group, but the difference was not statistically significant (20.2% vs. 23.0%, 9.5% vs. 11.5%, both P>0.05). There was no significant difference in AFS scores between the two groups (P>0.05). There was no significant difference in menstrual improvement between the two groups at 12 weeks after surgery (P=0.630). More than one year after TCRA operation, there was no significant difference in pregnancy rate and live birth rate between the two groups (both P>0.05). Conclusions: In patients with mild to moderate IUA, compared with balloon stent alone after TCRA, balloon stent combined with intrauterine injection of ACP gel did not reduce the recurrence rate and adhesion severity of IUA, nor could it promote the improvement of menstrual pattern and postoperative reproductive outcome.

Key words: Hysteroscopes, Hyaluronic acid, Gels, Recurrence, Menstruation disorders, Pregnancy outcome, Intrauterine adhesion