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羊膜移植在预防宫腔粘连中的应用

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Author:: No author available

Journal Title:: Chinese Journal of Obstetrics and Gynecology

Issue:: 6

DOI:: 10.3760/cma.j.issn.0529-567x.2012.06.016

Key Word:: No keyword available

Abstract：宫腔粘连( intrauterine adhesions)又称Asherman综合征,是指由于各种因素所致宫腔或颈管基底层内膜损伤后,宫腔肌壁和(或)颈管相互粘连.妊娠及非妊娠时宫腔受到创伤、感染、子宫畸形以及遗传倾向等是形成宫腔粘连的原因;宫腔粘连的主要病理组织学变化为子宫内膜纤维化及瘢痕形成.临床上,宫腔粘连多表现为闭经或月经量减少、周期性腹痛、不孕以及妊娠后胎盘植入、胎儿生长受限、产后出血等[1],严重影响育龄妇女的生育健康.宫腔镜下宫腔粘连切除术(trans-cervical resection of adhesions,TCRA)是宫腔粘连治疗的标准术式,然而,重度宫腔粘连患者,由于子宫内膜基底层受到严重破坏后几乎不再具有再生功能[2],TCRA中电刀分离后的创面子宫内膜再生困难,加之术中电切分离及电凝止血时电热效应的存在,使得受热损伤的组织创面进行病理性修复并形成炎性肉芽组织及纤维瘢痕[3],进而造成裸露的无内膜覆盖的宫腔前后壁再次粘连.据报道,重度宫腔粘连患者宫腔再粘连率高达62.5％[4],这已成为妇科的棘手问题.

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