宫腔粘连研究进展与防治策略

Advances in Research and Prevention Strategies for Intrauterine Adhesions

摘要: 宫腔粘连是一种由子宫内膜基底层损伤引发的常见妇科疾病，临床主要表现为月经异常与生育障碍，严重影响患者身心健康。近年来研究深入揭示了其发病机制，涉及细胞外基质代谢、血管生成、局部凝血异常及间质细胞衰老等多个分子层面。诊断方面，影像学技术进一步提升了检出率，标准化宫腔评分与子宫内膜容受性标志物检测有助于更精准评估病情严重程度与生育预后。治疗以宫腔镜下粘连分离术为主，术后防治再粘连成为关键，综合应用物理屏障、生物活性材料(如间充质干细胞、富血小板血浆等)及辅助药物(如雌激素)可提升疗效。针对重度患者，个体化与多学科综合治疗策略日益重要。本文系统综述宫腔粘连的病因机制、诊断评估及防治进展，以期为临床实践提供参考，改善患者预后。

Abstract: Intrauterine adhesions are a common gynecological disease caused by damage to the basal layer of the endometrium. Clinically, they primarily manifest as menstrual abnormalities and fertility disorders, severely affecting patients’ physical and mental health. In recent years, research has provided in-depth insights into their pathogenesis, involving multiple molecular mechanisms such as extracellular matrix metabolism, angiogenesis, local coagulation abnormalities, and stromal cell senescence. In terms of diagnosis, advancements in imaging techniques have further improved detection rates. Standardized intrauterine adhesion scoring systems and the detection of markers for endometrial receptivity aid in more accurately assessing disease severity and reproductive prognosis. Treatment primarily involves hysteroscopic adhesiolysis, with postoperative prevention of re-adhesion being a critical focus. The combined application of physical barriers, bioactive materials (such as mesenchymal stem cells, platelet-rich plasma, etc.), and adjuvant medications (such as estrogen) can enhance therapeutic efficacy. For patients with severe conditions, personalized and multidisciplinary comprehensive treatment strategies are increasingly important. This article systematically reviews the etiology, mechanisms, diagnostic evaluation, and advancements in the prevention and treatment of intrauterine adhesions, aiming to provide references for clinical practice and improve patient prognosis.