杨木汤与透明质酸凝胶治疗宫腔镜粘连松解术后宫腔再粘连的疗效及安全性分析：回顾性研究。
Yangmo decoction versus hyaluronic acid gel in women with intrauterine re-adhesion after hysteroscopic adhesiolysis: a retrospective efficacy and safety analysis.
机构信息
Department of Gynecology of Jinshan Campus, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
出版信息
BMC Womens Health. 2023 Sep 9;23(1):480. doi: 10.1186/s12905-023-02598-4.
BACKGROUND
Hysteroscopic adhesiolysis is the preferred primary method for intrauterine adhesion. However, there is about a 60% of chance of re-adhesion after surgery. The objectives of the study were to evaluate the efficacy and safety of Yangmo decoction as a secondary treatment in preventing intrauterine re-adhesion against those of hyaluronic acid gel.
METHODS
Women received oral Yangmo decoction (YD cohort, n = 105) or intrauterine hyaluronic acid gel (HA cohort, n = 125) or did not receive secondary re-adhesion prevention treatments (EP cohort, n = 165) after hysteroscopic adhesiolysis for 6 months. In addition, all women have received 3 mg of oral estrogen and 20 mg oral progesterone combination after hysteroscopic adhesiolysis for 3 months. Intrauterine re-adhesion after hysteroscopic adhesiolysis after 6 months with or without secondary treatment(s) was detected using hysteroscopy. The extent of the cavity, type of adhesion, and the menstrual pattern were included to define the American Fertility Society classification of intrauterine re-adhesions (AFS) score.
RESULTS
Fewer numbers of women suffered from intrauterine re-adhesion after hysteroscopic adhesiolysis in the YD cohort than those of the HA (15(14%) vs. 40(32%), p = 0.0019) and the EP (15(14%) vs. 58(35%). p = 0.0001) cohorts. Among women who developed intrauterine re-adhesion, AFS score was fewer for women of the YD cohort than those of HA (2(2-1) vs. 4(4-3), p < 0.001) and the EP (2(2-1) vs. 4(4-4), p < 0.001) cohorts. AFS score after surgery was fewer for women of the HA cohort than those of the EP cohort (p < 0.05). Higher numbers of women of the YD cohort retained pregnancies after 6-months of treatment than those of the HA (55(52%) vs. 45(36%), p = 0.0161) and EP (55(52%) vs. 35(21%), p < 0.0001) cohorts. Among women who develop re-adhesion, 10(10%) women of the YD cohort only had successful pregnancies.
CONCLUSIONS
Yangmo decoction for 6 months after hysteroscopic adhesiolysis can reduce AFS score, prevent intrauterine re-adhesion, and increases the chances of successful pregnancies of women.
LEVEL OF EVIDENCE
IV.
TECHNICAL EFFICACY
Stage 5.
背景
宫腔镜粘连松解术是治疗宫腔粘连的首选主要方法。然而，手术后再次粘连的几率约为 60%。本研究的目的是评估养膜汤作为二级治疗预防宫腔再粘连的疗效和安全性，并与透明质酸凝胶进行比较。
方法
宫腔镜粘连松解术后 6 个月，患者接受口服养膜汤（YD 组，n=105）或宫腔内透明质酸凝胶（HA 组，n=125）或不接受二次粘连预防治疗（EP 组，n=165）。此外，所有患者在宫腔镜粘连松解术后 3 个月均接受 3mg 口服雌激素和 20mg 口服孕激素联合治疗。宫腔镜检查评估宫腔镜粘连松解术后 6 个月有无宫腔再次粘连。宫腔粘连的范围、粘连类型和月经模式均纳入美国生育协会（AFS）宫腔粘连分类评分。
结果
YD 组宫腔粘连松解术后宫腔再粘连的患者数量明显少于 HA 组（15 例[14%]比 40 例[32%]，p=0.0019）和 EP 组（15 例[14%]比 58 例[35%]，p=0.0001）。发生宫腔再粘连的患者中，YD 组的 AFS 评分明显低于 HA 组（2（2-1）比 4（4-3），p<0.001）和 EP 组（2（2-1）比 4（4-4），p<0.001）。HA 组术后 AFS 评分明显低于 EP 组（p<0.05）。YD 组宫腔粘连松解术后妊娠的患者比例明显高于 HA 组（55 例[52%]比 45 例[36%]，p=0.0161）和 EP 组（55 例[52%]比 35 例[21%]，p<0.0001）。在发生再粘连的患者中，YD 组仅 10 例（10%）患者成功妊娠。
结论
宫腔镜粘连松解术后 6 个月使用养膜汤可降低 AFS 评分，预防宫腔再粘连，提高患者成功妊娠的机会。
证据水平
IV
技术功效
5 级
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