宫腔粘连分离术后预防复发的研究进展
Research Progress on Prevention of Recurrence after Intrauterine Adhesions Lysis
DOI: 10.12677/acm.2026.1682851, PDF,   
作者: 张云飞：赣南医科大学第一临床医学院，江西 赣州；广东省人民医院赣州医院(赣州市立医院)妇产科，江西 赣州；蔡慧华*：赣南医科大学第一临床医学院，江西 赣州；广东省人民医院赣州医院(赣州市立医院)妇产科，江西 赣州；南方医科大学珠江医院妇产科，广东 广州
关键词: 宫腔粘连；Asherman综合征；复发；预防；间充质干细胞；富血小板血浆；中医药治疗；研究进展；Intrauterine Adhesions； Asherman Syndrome； Recurrence； Prevention； Mesenchymal Stem Cells； Platelet-Rich Plasma； Traditional Chinese Medicine； Research Progress
摘要: 宫腔粘连(intrauterine adhesions, IUA)作为子宫性不孕和月经过少的主要病因之一，其本质是子宫内膜损伤修复障碍所致的纤维化。现阶段IUA治疗的首选方法是经宫腔镜宫腔粘连分离术，辅以屏障隔离创面减少再粘连和雌激素促进内膜修复，但术后复发率仍居高不下，尤其在中重度IUA患者中更为突出，亟需探究基于病理机制的联合治疗策略。因此本文将综合国内外关于IUA防治方法及途径的研究进展做详细阐述，以“屏障阻隔–微环境调控–分子靶向修复”三位一体防治新模式为统领，系统梳理物理屏障、凝胶类、雌激素、间充质干细胞、富血小板血浆、中医药及其他潜在治疗选择的最新进展，以期为临床IUA分离术后预防复发的策略提供依据。
Abstract: Intrauterine adhesions (IUA), as one of the main causes of uterine infertility and hypomenorrhea, is essentially fibrosis caused by impaired repair of endometrial injury. The current first-line treatment for IUA is transcervical resection of adhesions (TCRA), supplemented with barrier isolation of the wound surface to reduce re-adhesion and estrogen therapy to promote endometrial repair. However, the postoperative recurrence rate remains high, especially in moderate-to-severe IUA patients, highlighting the urgent need for combination treatment strategies based on pathogenic mechanisms. This article reviews the research progress on IUA prevention and treatment methods both domestically and internationally, guided by the “barrier isolation - microenvironment regulation - molecular targeted repair” trinity prevention and treatment model. It systematically summarizes the latest advances in physical barriers, gel barriers, estrogen therapy, mesenchymal stem cells, platelet-rich plasma, traditional Chinese medicine, and other potential therapeutic options, and describes how delivery strategies such as injectable hydrogels efficiently integrate the above therapies, aiming to provide evidence for clinical strategies to prevent recurrence after IUA lysis.
文章引用：张云飞, 蔡慧华. 宫腔粘连分离术后预防复发的研究进展[J]. 临床医学进展, 2026, 16(8): 782-790. https://doi.org/10.12677/acm.2026.1682851

参考文献

[1] Chen, J., Huang, Q., Chen, W., Wu, J., Zheng, L., You, H., et al. (2024) Transcriptomics of Tissue Exosomes to Investigate miR-195-5p’s Amelioration of Endometrial Fibrosis via the Yap-Smad7 Pathway: An Animal Study. Journal of Translational Medicine, 22, Article No. 1050.
https://doi.org/10.1186/s12967-024-05871-8
[2] Du, Y., Shuai, R., Luo, S., Jin, Y., Xu, F., Zhang, J., et al. (2024) Exploring the Molecular Mechanism of Estrogen Therapy Effectiveness after TCRA in IUA Patients at Single-Cell Level. Biology Direct, 19, Article No. 142.
https://doi.org/10.1186/s13062-024-00583-x
[3] Xiong, Z., Ma, Y., He, J., Li, Q., Liu, L., Yang, C., et al. (2023) Apoptotic Bodies of Bone Marrow Mesenchymal Stem Cells Inhibit Endometrial Stromal Cell Fibrosis by Mediating the Wnt/β-Catenin Signaling Pathway. Heliyon, 9, e20716.
https://doi.org/10.1016/j.heliyon.2023.e20716
[4] (2017) AAGL Practice Report: Practice Guidelines on Intrauterine Adhesions Developed in Collaboration with the European Society of Gynaecological Endoscopy (ESGE). Journal of Minimally Invasive Gynecology, 24, 695-705.
https://doi.org/10.1016/j.jmig.2016.11.008
[5] Wang, Y., Zhao, Y., Ge, Y., Cen, J., Liao, Y. and Xu, G. (2022) Reproductive Outcomes and Reproductive Tract Microbiota Shift in Women with Moderate-to-Severe Intrauterine Adhesions Following 30-Day Post-Hysteroscopic Placement of Balloon Stents or Intrauterine Contraceptive Devices: A Randomized Controlled Trial. eClinicalMedicine, 43, Article ID: 101200.
https://doi.org/10.1016/j.eclinm.2021.101200
[6] Ding, H., Zhang, H., Qiao, R., Sun, N., Ji, Y., Pang, W., et al. (2024) Comparing the Efficacy and Pregnancy Outcome of Intrauterine Balloon and Intrauterine Contraceptive Device in the Prevention of Adhesion Reformation after Hysteroscopic Adhesiolysis in Infertile Women: A Prospective, Randomized, Controlled Trial Study. Reproductive Biology and Endocrinology, 22, Article No. 49.
https://doi.org/10.1186/s12958-024-01222-w
[7] Trinh, T.T., Nguyen, K.D., Pham, H.V., Ho, T.V., Nguyen, H.T., O’Leary, S., et al. (2022) Effectiveness of Hyaluronic Acid Gel and Intrauterine Devices in Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis in Infertile Women. Journal of Minimally Invasive Gynecology, 29, 284-290.
https://doi.org/10.1016/j.jmig.2021.08.010
[8] Zhao, J., Zhang, L., Liang, J., Zhao, H., Wang, Z. and Pang, Y. (2023) The Effect of the Combined Use of an Intrauterine Device and a Foley Balloon in the Prevention of Adhesion Following Hysteroscopic Adhesiolysis. Women & Health, 63, 1-7.
https://doi.org/10.1080/03630242.2022.2144984
[9] Tang, R., Zhang, W., Xiao, X., Li, W., Chen, X. and Wang, X. (2024) Intrauterine Interventions Options for Preventing Recurrence after Hysteroscopic Adhesiolysis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Archives of Gynecology and Obstetrics, 309, 1847-1861.
https://doi.org/10.1007/s00404-024-07460-y
[10] Feng, L., Sun, Y., Zhang, S., Qian, Y., Fang, S., Yang, B., et al. (2024) A Novel Intrauterine Estrogen-Releasing System for Preventing the Postoperative Recurrence of Intrauterine Adhesion: A Multicenter Randomized Controlled Study. BMC Medicine, 22, Article No. 395.
https://doi.org/10.1186/s12916-024-03608-4
[11] Dou, Y., Yu, T., Li, Z., Wang, J., Jiang, Y. and Liu, Y. (2022) Short-and Long-Term Outcomes of Postoperative Intrauterine Application of Hyaluronic Acid Gel: A Meta-Analysis of Randomized Controlled Trials. Journal of Minimally Invasive Gynecology, 29, 934-942.
https://doi.org/10.1016/j.jmig.2022.05.006
[12] Unanyan, A., Pivazyan, L., Krylova, E., Obosyan, L. and Ishchenko, A. (2022) Comparison of Effectiveness of Hyaluronan Gel, Intrauterine Device and Their Combination for Prevention Adhesions in Patients after Intrauterine Surgery: Systematic Review and Meta-Analysis. Journal of Gynecology Obstetrics and Human Reproduction, 51, Article ID: 102334.
https://doi.org/10.1016/j.jogoh.2022.102334
[13] Mao, X., Tao, Y., Cai, R., Zhang, J., Gao, H., Chen, Q., et al. (2020) Cross-Linked Hyaluronan Gel to Improve Pregnancy Rate of Women Patients with Moderate to Severe Intrauterine Adhesion Treated with IVF: A Randomized Controlled Trial. Archives of Gynecology and Obstetrics, 301, 199-205.
https://doi.org/10.1007/s00404-019-05368-6
[14] Vitale, S.G., Riemma, G., Carugno, J., Perez-Medina, T., Alonso Pacheco, L., Haimovich, S., et al. (2022) Postsurgical Barrier Strategies to Avoid the Recurrence of Intrauterine Adhesion Formation after Hysteroscopic Adhesiolysis: A Network Meta-Analysis of Randomized Controlled Trials. American Journal of Obstetrics and Gynecology, 226, 487-498.e8.
https://doi.org/10.1016/j.ajog.2021.09.015
[15] Luo, Y., Sun, Y., Huang, B., Chen, J., Xu, B. and Li, H. (2024) Effects and Safety of Hyaluronic Acid Gel on Intrauterine Adhesion and Fertility after Intrauterine Surgery: A Systematic Review and Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. American Journal of Obstetrics and Gynecology, 231, 36-50.35.
https://doi.org/10.1016/j.ajog.2023.12.039
[16] Dong, R., Ma, S., Zhao, X., Wang, B., Roy, M., Yao, L., et al. (2022) Recent Progress of Bioinspired Hydrogel-Based Delivery System for Endometrial Repair. Frontiers in Bioengineering and Biotechnology, 10, Article 1013217.
https://doi.org/10.3389/fbioe.2022.1013217
[17] Wang, J., Yang, C., Xie, Y., Chen, X., Jiang, T., Tian, J., et al. (2021) Application of Bioactive Hydrogels for Functional Treatment of Intrauterine Adhesion. Frontiers in Bioengineering and Biotechnology, 9, Article 760943.
https://doi.org/10.3389/fbioe.2021.760943
[18] 杨洁, 徐大宝, 金毅然, 等. 宫腔粘连患者TCRA术后不同剂量雌激素对子宫内膜血流的影响[J]. 实用妇产科杂志, 2025, 41(2): 130-135.
[19] Guo, J., Li, T., Liu, Y., Xia, E., Xiao, Y., Zhou, F., et al. (2017) A Prospective, Randomized, Controlled Trial Comparing Two Doses of Oestrogen Therapy after Hysteroscopic Adhesiolysis to Prevent Intrauterine Adhesion Recurrence. Reproductive BioMedicine Online, 35, 555-561.
https://doi.org/10.1016/j.rbmo.2017.07.011
[20] Liu, L., Huang, X., Xia, E., Zhang, X., Li, T. and Liu, Y. (2019) A Cohort Study Comparing 4 Mg and 10 Mg Daily Doses of Postoperative Oestradiol Therapy to Prevent Adhesion Reformation after Hysteroscopic Adhesiolysis. Human Fertility, 22, 191-197.
https://doi.org/10.1080/14647273.2018.1444798
[21] Song, R., Ma, C., Li, H., et al. (2025) A Temperature Responsive Hydrogel Encapsulated with Adipose-Derived Stem Cells and Melanin Promotes Repair and Regeneration of Endometrial Injury. Bioengineering & Translational Medicine, 10, e10714.
[22] Liang, Y., Shuai, Q., Zhang, X., Jin, S., Guo, Y., Yu, Z., et al. (2024) Incorporation of Decidual Stromal Cells Derived Exosomes in Sodium Alginate Hydrogel as an Innovative Therapeutic Strategy for Advancing Endometrial Regeneration and Reinstating Fertility (Adv. Healthcare Mater. 13/2024). Advanced Healthcare Materials, 13, e2303674.
https://doi.org/10.1002/adhm.202470089
[23] Wang, Y., Yin, L., Sun, X., Yang, Q., Yu, Y., Rong, Y., et al. (2025) Retrospective Analysis of Autologous Bone Marrow Mesenchymal Stem Cells as Adjuvant Therapy in Recurrent Intrauterine Adhesions. Archives of Gynecology and Obstetrics, 311, 789-799.
https://doi.org/10.1007/s00404-025-07952-5
[24] Zhang, W., Wang, H. and Deng, C. (2025) Advances in Human Umbilical Cord Mesenchymal Stem Cells-Derived Extracellular Vesicles and Biomaterial Assemblies for Endometrial Injury Treatment. World Journal of Stem Cells, 17, Article ID: 97905.
https://doi.org/10.4252/wjsc.v17.i1.97905
[25] Wang, L., Yu, C., Chang, T., Zhang, M., Song, S., Xiong, C., et al. (2020) In Situ Repair Abilities of Human Umbilical Cord-Derived Mesenchymal Stem Cells and Autocrosslinked Hyaluronic Acid Gel Complex in Rhesus Monkeys with Intrauterine Adhesion. Science Advances, 6, eaba635.
https://doi.org/10.1126/sciadv.aba6357
[26] Lin, X., Fang, Y., Mi, X., Fu, J., Chen, S., Wu, M., et al. (2024) Intrauterine Injection of Bioengineered Hydrogel Loaded Exosomes Derived from HUCM Stem Cells and Spermidine Prominently Augments the Pregnancy Rate in Thin Endometrium Rats. Regenerative Therapy, 27, 63-72.
https://doi.org/10.1016/j.reth.2024.02.003
[27] Lin, Y., Li, Y., Chen, P., Zhang, Y., Sun, J., Sun, X., et al. (2023) Exosome-Based Regimen Rescues Endometrial Fibrosis in Intrauterine Adhesions via Targeting Clinical Fibrosis Biomarkers. Stem Cells Translational Medicine, 12, 154-168.
https://doi.org/10.1093/stcltm/szad007
[28] Yu, S., Zhang, X., Li, W., Lu, Y., Xu, X., Hu, R., et al. (2024) Thermosensitive Hydrogel as a Sustained Release Carrier for Mesenchymal Stem Cell-Derived Extracellular Vesicles in the Treatment of Intrauterine Adhesion. Journal of Nanobiotechnology, 22, Article No. 570.
https://doi.org/10.1186/s12951-024-02780-2
[29] Tang, R., Xiao, X., He, Y., Qiu, D., Zhang, W. and Wang, X. (2023) Clinical Evaluation of Autologous Platelet-Rich Plasma Therapy for Intrauterine Adhesions: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 14, Article 1183209.
https://doi.org/10.3389/fendo.2023.1183209
[30] Zhang, W., Tang, R., Xiao, X., Liu, J., Li, M. and Wang, X. (2025) A Comparative Study on the Efficacy of Subendometrial versus Intrauterine Platelet-Rich Plasma Injections for Treating Intrauterine Adhesions: A Retrospective Cohort Study. Journal of Minimally Invasive Gynecology, 32, 378-385.e1.
https://doi.org/10.1016/j.jmig.2024.11.007
[31] Xie, X., Ao, X., Xu, R., Lv, H., Tan, S., Wu, J., et al. (2024) Injectable, Stable, and Biodegradable Hydrogel with Platelet-Rich Plasma Induced by L-Serine and Sodium Alginate for Effective Treatment of Intrauterine Adhesions. International Journal of Biological Macromolecules, 270, Article ID: 132363.
https://doi.org/10.1016/j.ijbiomac.2024.132363
[32] Zheng, X., Huang, R., Yin, L., Yao, M., Chu, J., Yang, F., et al. (2025) Injectable Antioxidant Hyaluronan/Chitosan Hydrogel as a Platelet-Rich Plasma and Stem Cell Carrier to Promote Endometrial Regeneration and Fertility Restoration. Acta Biomaterialia, 195, 201-215.
https://doi.org/10.1016/j.actbio.2025.01.062
[33] 吴丹. 补肾活血汤对宫腔粘连术后肾虚血瘀患者凝血功能及炎症反应的影响[J]. 中国实验方剂学杂志, 2017, 23(9): 174-178.
[34] 蒋建发, 游卉, 赵行平, 等. 宫腔粘连中西医结合诊疗中国专家共识(2024年版) [J]. 中国实用妇科与产科杂志, 2024, 40(8): 819-825.
[35] Mao, L., Wang, X., Sun, Y., Yang, M., Chen, X., Cui, L., et al. (2023) Platelet-Rich Fibrin Improves Repair and Regeneration of Damaged Endometrium in Rats. Frontiers in Endocrinology, 14, Article 1154958.
https://doi.org/10.3389/fendo.2023.1154958
[36] Wang, Z., Yang, M., Mao, L., Wang, X., Wang, S., Cui, G., et al. (2021) Efficacy and Safety of Autologous Platelet‐Rich Fibrin for the Treatment of Infertility with Intrauterine Adhesions. Journal of Obstetrics and Gynaecology Research, 47, 3883-3894.
https://doi.org/10.1111/jog.14964
[37] 陈麟凤, 杨慕坤. 自体富血小板纤维蛋白(PRF)治疗宫腔粘连专家共识[J]. 临床输血与检验, 2022, 24(3): 279-284.
[38] 李文怡, 张琬琳, 肖西峰. 富血小板纤维蛋白应用于子宫内膜损伤修复研究进展[J]. 中国妇产科临床杂志, 2025, 26(2): 156-158.
[39] 王国云, 冷金花, 袁明, 等. 子宫内膜类器官构建与临床转化专家共识(2025年版) [J]. 中国实用妇科与产科杂志, 2025, 41(2): 212-219.
[40] Jiang, X., Li, X., Fei, X., Shen, J., Chen, J., Guo, M., et al. (2021) Endometrial Membrane Organoids from Human Embryonic Stem Cell Combined with the 3D Matrigel for Endometrium Regeneration in Asherman Syndrome. Bioactive Materials, 6, 3935-3946.
https://doi.org/10.1016/j.bioactmat.2021.04.006
[41] Xu, Y., Cai, S., Wang, Q., Cheng, M., Hui, X., Dzakah, E.E., et al. (2023) Multi-Lineage Human Endometrial Organoids on Acellular Amniotic Membrane for Endometrium Regeneration. Cell Transplantation, 32, 1-10.
https://doi.org/10.1177/09636897231218408
[42] Wang, W., Chang, P., Jin, J., Pu, F., Li, D., Bai, Y., et al. (2024) Cardioprotective Effects of Curcumin against Diabetic Cardiomyopathies: A Systematic Review and Meta-Analysis of Preclinical Studies. Phytomedicine, 129, Article ID: 155619.
https://doi.org/10.1016/j.phymed.2024.155619
[43] Zhang, W., He, Y., Chu, Y., Zhai, Y., Qian, S., Wang, X., et al. (2024) Amorphous Curcumin-Based Hydrogels to Reduce the Incidence of Post-Surgical Intrauterine Adhesions. Regenerative Biomaterials, 11, rbae043.
https://doi.org/10.1093/rb/rbae043
[44] Atia, M.M., Abdel-Tawab, H.S., Mostafa, A.M. and Mobarak, S.A. (2022) Nanocurcumin and Curcumin Prevent N, N’-Methylenebisacrylamide-Induced Liver Damage and Promotion of Hepatic Cancer Cell Growth. Scientific Reports, 12, No. 1.
https://doi.org/10.1038/s41598-022-12406-y

为你推荐