羊膜移植在宫腔镜下宫腔粘连分离术术后预防宫腔粘连的相关研究

摘要

目的：观察羊膜移植在宫腔镜下宫腔粘连分离术（TCRA）术后预防宫腔粘连（IUA）的疗效，以评价羊膜移植对IUA的价值。方法：选取2013年1月至2015年6月我院收治的中重度IUA患者90例，随机分为A、B、C 3组，每组30例。A组：TCRA术后放置宫腔型节育器；B组：TCRA术后放置14号Foley球囊；C组：TCRA术后放置14号Foley球囊，球囊外敷新鲜羊膜。术后1个月、2个月采用宫腔纤维软镜检查行AFS评分，术中取子宫内膜活检行HE染色检测内膜腺体数量，观察恢复情况，比较3组治疗方法的临床疗效。术后随访3组感染发生率。结果：C组术后2个月子宫形态、宫腔容积及月经恢复情况均优于A组和B组（P＜0.05）；C组HE染色子宫内膜腺体数量明显高于A组和B组（P＜0.01）；C组感染率明显低于A组和B组（P＜0.05）。结论：羊膜移植对TCRA术后预防宫腔再次粘连的效果明显优于宫腔型节育器及Foley球囊，可为中重度IUA患者提供安全、有效的治疗方法。%Objective:TO observe the therapeutic effect of amniotic membrane transplantation on the preven-tion of intrauterine adhesions after transcervical resection of adhesions, to assess the value of amniotic membrane transplantation for intrauterine adhesions. Methods:Ninety cases of severe intrauterine adhesions patients admitted to Taizhou Central Hospital from Jan. 2013 to Jan. 2015 were selected. They were randomly divided into Group A, B and C three group (30 cases in each group). Group A:Uterine cavity type contraceptive devices were indwelled in 30 patients after transcervical resection of adhesion (TCRA);Group B:Foley saccule urinary catheters (14 Fr) were indwelled in 30 cases after TCRA;Group C:Foley sacclue urinary catheters (14 Fr) covered with fresh amniotic membrane were indwelled in the uterine cavity of 30 patients after TCRA. Patients were inspected with hysteroscopy after one and two months of operation to calculate AFS score in order to compare the clinical curative effect of three kinds of treatment method. The endometrial tissues were collected during operation and stained with HE, then, the number of the endometrial gland was counted to observe the situation of the menstrual recovery. The incidences of infection in the three groups were followed-up. Results:After two months of operation, conditions of uterine form, uterine volume and menstruation recovery were better in Group C than those in Group A and Group B (P<0.05). The endometrial glands count that was performed after HE staining was much higher in Group C than that in Group A and Group B (P<0.01). The positive rates of infection in Group C were lower than those in Group A and Group B (P<0.05). Conclusion:The effect that amniotic membrane transplantation is used to prevent intrauterine readbesion after transcervical resection of adhesions is much better than using uterine cavity type and Foley saccule urinary cath-eter. Amniotic membrane transplantation is a safe and effective treatment for severe intrauterine adhesions patients.