Zhang Wanlin, Tang Ruonan, Xiao Xifeng, Liu Jin, Li Mao, Wang Xiaohong
Reproductive Medicine Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, (Drs. Zhang, Tang, Xiao, Liu, Li and Wang) Xi'an, Shaanxi, China.
Reproductive Medicine Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, (Drs. Zhang, Tang, Xiao, Liu, Li and Wang) Xi'an, Shaanxi, China; Xi'an Medical University, (Dr. Tang) Xi'an, Shaanxi, China.
J Minim Invasive Gynecol. 2025 Apr;32(4):378-385.e1. doi: 10.1016/j.jmig.2024.11.007. Epub 2024 Dec 4.
Comparison of the clinical efficacy of hysteroscopic subendometrial injection of platelet-rich plasma (PRP) and intrauterine instillation of PRP for the treatment of intrauterine adhesions.
A Retrospective Cohort Study.
University hospital.
Patients who underwent hysteroscopic transcervical excision of adhesions from September 1, 2020, to July 31, 2023, and were treated with PRP in the postoperative period were included.
Subendometrial PRP injection group (referred to as SE-PRP group) and intrauterine PRP infusion group (referred to as IU-PRP group) MEASURES AND MAIN RESULTS: A total of 299 patients with moderate-to-severe IUA treated with PRP after Transcervical resection of adhesions (TCRA) were included. The primary outcome metric was the clinical pregnancy rate, and the secondary outcome metrics were the rate of menstrual improvement and the AFS score. The results showed that: the AFS reduction scores was greater in the SE-PRP group than in the IU-PRP group (8 vs 7, p = 0.019); the menstrual improvement rate in the SE-PRP group was higher than that in the IU-PRP group (77.0% vs 52.9%, p < 0.001); and the clinical pregnancy rate in the SE-PRP group was similar than that in the clinical pregnancy rate in the IU-PRP group (28.4% vs 20.4%, p = 0.208). The results of multifactorial logistic regression analysis showed that the clinical pregnancy rate in the SE-PRP group was significantly higher than that in the IU-PRP group (OR = 2.020, 95% CI = 1.050-3.889, p = 0.035). The results of the propensity score matching (PSM) analysis showed that: the median postoperative AFS score reduction was significantly higher in the SE-PRP group than in the IU-PRP group (p = 0.015); and the rate of improvement in menstruation was significantly higher in the matched SE-PRP group (75.0% vs 58.1%, p = 0.027) and clinical pregnancy rates were higher in the SE-PRP group (29.4% vs 16.2%, p = 0.043).
Hysteroscopic intrauterine PRP injection is more clinically effective than intrauterine PRP infusion for patients with moderate to severe intrauterine adhesions, resulting in greater reduction in adhesion scores, improvement in menstrual rate, and increased clinical pregnancy rate.
比较宫腔镜下子宫内膜下注射富血小板血浆（PRP）与宫腔内灌注PRP治疗宫腔粘连的临床疗效。
回顾性队列研究。
大学医院。
纳入2020年9月1日至2023年7月31日接受宫腔镜下经宫颈粘连切除术且术后接受PRP治疗的患者。
子宫内膜下PRP注射组（简称SE-PRP组）和宫腔内PRP灌注组（简称IU-PRP组）
共纳入299例经宫颈粘连切除术（TCRA）后接受PRP治疗的中重度宫腔粘连患者。主要结局指标为临床妊娠率，次要结局指标为月经改善率和美国生育学会（AFS）评分。结果显示：SE-PRP组的AFS降低分数高于IU-PRP组（8分对7分，p = 0.019）；SE-PRP组的月经改善率高于IU-PRP组（77.0%对52.9%，p < 0.001）；SE-PRP组的临床妊娠率与IU-PRP组的临床妊娠率相似（28.4%对20.4%，p = 0.208）。多因素logistic回归分析结果显示，SE-PRP组的临床妊娠率显著高于IU-PRP组（OR = 2.020，95%CI = 1.050 - 3.889，p = 0.035）。倾向评分匹配（PSM）分析结果显示：SE-PRP组术后AFS评分降低中位数显著高于IU-PRP组（p = 0.015）；匹配后的SE-PRP组月经改善率显著更高（75.0%对58.1%，p = 0.027），SE-PRP组临床妊娠率更高（29.4%对16.2%，p = 0.043）。
对于中重度宫腔粘连患者，宫腔镜下宫腔内PRP注射比宫腔内PRP灌注临床效果更佳，可使粘连评分降低更多、月经率改善、临床妊娠率提高。
