Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2019, Vol. 15 ›› Issue (04): 420 -425. doi: 10.3877/cma.j.issn.1673-5250.2019.04.011

Special Issue:

Original Article

Effectiveness and safety of amniotic membrane transplantation in preventing recurrence of uterine adhesion after transcervical resection of adhesions

Dan Cheng1, Yuebin Gong2, Jiao Chen1, Xueyao Li1, Xiaochen Wang1, Bing Qu1, Jing Yang1,()   

  1. 1. Center for Reproductive Medicine, Renmin Hospital of Wuhan University/ Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan 430060, Hebei Province, China
    2. Center for Reproductive Medicine, Renmin Hospital of Wuhan University/ Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan 430060, Hebei Province, China; Department of Obstetrics and Gynecology, Hanchuan People′s Hospital, Hanchuan 431600, Hebei Province, China
  • Received:2019-02-18 Revised:2019-07-01 Published:2019-08-01
  • Corresponding author: Jing Yang
  • About author:
    Corresponding author: Yang Jing, Email:
  • Supported by:
    National Natural Science Foundation of China(81801481); Special Fund for Clinical Medical Research of Chinese Medical Association-Research and Development Project for Young Doctors of Reproductive Medicine(17020460715)
Objective

To investigate the effectiveness and safety of amniotic membrane transplantation in preventing recurrence of intrauterine adhesions (IUA) after transcervical resection of adhesions (TCRA).

Methods

From December 2016 to August 2017, a total of 121 patients who underwent TCRA due to moderate or severe IUA in the Center for Reproductive Medicine of Renmin Hospital of Wuhan University were enrolled into this study. According to the odd-numbered and even-numbered operation days, they were divided into two groups: group A (n=76) for amniotic membrane transplantation, group B (n=45) for conventional treatment, induding intrauterine device (IUD) and absorbable biomedical membrane. The general clinical data, curative effects (uterine cavity recovery, menstrual volume changes, postoperative endometrial thickness) and incidence of postoperative adverse reactions were compared between two groups. Independent-samples t test was used to statistically compare the age, gestational age and endometrial thickness between two groups. Wilcoxon rank sum test was used to statistically analyze body mass index (BMI) and disease course. The composition ratio of IUA degree, menstruation improvement rate and adverse reaction rate were analyzed by chi-square test, continuity correction of chi-square test or Fisher′s exact test. The procedures followed in this study was in accordance with the ethical standards established by the Human Beings Test Committee of Renmin Hospital of Wuhan University, and was approved by the committee (Approval No. WDRY2016-Q007). Informed consent was obtained from each participate.

Results

①There were no significant differences in the aspects of age, gestational age, BMI, disease course, composition ratio of abnormal menstruation types before TCRA and composition ratio of IUA degree between two groups (P>0.05). ② The therapeutic effects of TCRA in two groups were evaluated as follows. The recovery rate of uterine cavity in group A was 84.2% (64/76), which was significantly higher than that of 64.4% (29/45) in group B, the improvement rate of menstrual volume of group A was 75.0% (57/76), which was significantly higher than that of 37.8% (17/45) in group B, and the thickness of postoperative endometrium of group A was (4.2±1.6) mm, which was significantly higher than that of (3.6±1.5) mm in group B. All the above indexes between two groups were statistically significant (χ2=4.367, 16.485, 2.168; P=0.037, <0.001, =0.033). ③In two groups of patients, none of them had serious complications such as water poisoning and uterine perforation. In addition, there were no significant differences in postoperative adverse reactions between two groups, such as the incidences of recurrent irregular vaginal bleeding during menstruation, more vaginal secretions, abdominal pain and pruritus vulvae (P>0.05).

Conclusions

Amniotic membrane transplantation is one of the effective methods to prevent the recurrence of adhesion after TCRA of IUA patients. While, its long-term safety needs to be confirmed by large-sample randomized, controlled trials.

表1 美国生殖学会对于宫腔黏连评分标准[8]
表2 2组宫腔黏连患者一般临床资料比较
表3 2组宫腔黏连患者宫腔镜下宫腔黏连分离术疗效评价
表4 2组宫腔黏连患者宫腔镜下宫腔黏连分离术后不良反应比较[例数(%)]
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