Postoperative Adjuvant Measures for Preventing Adhesion Recurrence and Improving the Reproductive Outcome after Hysteroscopic Adhsiolysis

doi:10.12280/gjszjk.20210534

Abstract

Abstract:

Hysteroscopic adhesiolysis is the universal treatment for intrauterine adhesion. However the adhesion recurrence rate is high, and the reproductive outcome is not satisfied. Therefore, postoperative adjuvant measures are commonly used to improve the prognosis. Traditional adjuvant measures mainly include physical barriers, oral and topical medications, etc. Foley catheter is often combined with oral estrogen therapy to improve the prognosis, which has been widely used in clinical practice for decades due to its advantages of stable therapeutic effect and cost-effective. In recent years, a variety of novel adjuvant measures based on biologicals and biomaterials have been used in the comprehensive treatment of intrauterine adhesion. Among biologicals, platelet-rich plasma and stem cells have shown better therapeutic effects of advancing endometrial repair and improving reproductive outcomes. In addition, some novel adjuvant measures based on biological materials such as gels and scaffolds have also shown good therapeutic effects, which brings a hope to refractory intrauterine adhesion. We review the research progress of traditional and novel adjuvant measures to prevent the recurrence of intrauterine adhesion, and to improve reproductive outcome after operation. This review also provides some clinical insights for the comprehensive treatment of intrauterine adhesion.

Key words: Uterine diseases, Tissue adhesions, Stem cells, Platelet-rich plasma, Hysteroscopy, Estrogens, Intrauterine adhesion

QIU Dan-er, ZHANG Wan-lin, WANG Xiao-hong. Postoperative Adjuvant Measures for Preventing Adhesion Recurrence and Improving the Reproductive Outcome after Hysteroscopic Adhsiolysis[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(1): 46-51.

References 40

[1]	Myers EM, Hurst BS. Comprehensive management of severe Asherman syndrome and amenorrhea[J]. Fertil Steril, 2012, 97(1):160-164. doi: 10.1016/j.fertnstert.2011.10.036. doi: 10.1016/j.fertnstert.2011.10.036 URL
[2]	Lin X, Wei M, Li TC, et al. A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 170(2):512-516. doi: 10.1016/j.ejogrb.2013.07.018. doi: 10.1016/j.ejogrb.2013.07.018 URL
[3]	Haimov-Kochman R, Doviner V, Amsalem H, et al. Intraperitoneal levonorgestrel-releasing intrauterine device following uterine perforation: the role of progestins in adhesion formation[J]. Hum Reprod, 2003, 18(5):990-993. doi: 10.1093/humrep/deg203. doi: 10.1093/humrep/deg203 pmid: 12721174
[4]	Orhue AA, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis[J]. Int J Gynaecol Obstet, 2003, 82(1):49-56. doi: 10.1016/s0020-7292(03)00030-4. doi: 10.1016/s0020-7292(03)00030-4 URL
[5]	Zhu R, Duan H, Gan L, et al. Comparison of Intrauterine Suitable Balloon and Foley Balloon in the Prevention of Adhesion after Hysteroscopic Adhesiolysis[J]. Biomed Res Int, 2018, 2018:9494101. doi: 10.1155/2018/9494101. doi: 10.1155/2018/9494101 pmid: 30533444
[6]	Chen Y, Liu L, Luo Y, et al. Effects of Aspirin and Intrauterine Balloon on Endometrial Repair and Reproductive Prognosis in Patients with Severe Intrauterine Adhesion: A Prospective Cohort Study[J]. Biomed Res Int, 2017, 2017:8526104. doi: 10.1155/2017/8526104. doi: 10.1155/2017/8526104
[7]	Liu L, Huang X, Xia E, et al. A cohort study comparing 4 mg and 10 mg daily doses of postoperative oestradiol therapy to prevent adhesion reformation after hysteroscopic adhesiolysis[J]. Hum Fertil(Camb), 2019, 22(3):191-197. doi: 10.1080/14647273.2018.1444798. doi: 10.1080/14647273.2018.1444798
[8]	Guo J, Li TC, Liu Y, et al. A prospective, randomized, controlled trial comparing two doses of oestrogen therapy after hysteroscopic adhesiolysis to prevent intrauterine adhesion recurrence[J]. Reprod Biomed Online, 2017, 35(5):555-561. doi: 10.1016/j.rbmo.2017.07.011. doi: 10.1016/j.rbmo.2017.07.011 URL
[9]	Ge J, Chen Y, Yang H, et al. Expression and significance of estrogen receptor and progesterone receptor in endometrial tissue of patients with intrauterine adhesions[J]. Gland Surg, 2021, 10(4):1478-1486. doi: 10.21037/gs-21-232. doi: 10.21037/gs-21-232 URL
[10]	陈芳, 段华, 张颖, 等. 不同水平雌激素在宫腔粘连形成中的作用及相关机制[J]. 中华妇产科杂志, 2010, 45(12):917-920. doi: 10.3760/cma.j.issn.0529-567x.2010.12.009. doi: 10.3760/cma.j.issn.0529-567x.2010.12.009
[11]	Chi Y, He P, Lei L, et al. Transdermal estrogen gel and oral aspirin combination therapy improves fertility prognosis via the promotion of endometrial receptivity in moderate to severe intrauterine adhesion[J]. Mol Med Rep, 2018, 17(5):6337-6344. doi: 10.3892/mmr.2018.8685. doi: 10.3892/mmr.2018.8685
[12]	陈中萍, 黄鹰, 李德梅. 小剂量阿司匹林对宫腔粘连电切术子宫内膜及其血流变化的影响[J]. 药品评价, 2019, 16(12):37-39.
[13]	毛利云, 朱铮, 王屹雯, 等. 补肾填精行气活血法治疗中重度宫腔粘连疗效研究[J]. 陕西中医, 2020, 41(12):1731-1734. doi: 10.3969/j.issn.1000-7369.2020.12.013. doi: 10.3969/j.issn.1000-7369.2020.12.013
[14]	刘瑾, 肖西峰, 苗叶, 等. 重度宫腔粘连术后应用麒麟丸联合人工周期治疗临床疗效观察[J]. 生殖医学杂志, 2019, 28(9):1038-1042. doi: 10.3969/j.issn.1004-3845.2019.09.010. doi: 10.3969/j.issn.1004-3845.2019.09.010
[15]	何珍英. 金凤丸联合生物电刺激用于中重度宫腔粘连术后治疗的临床研究[J]. 智慧健康, 2020, 6(35):33-34,39. doi: 10.19335/j.cnki.2096-1219.2020.35.014. doi: 10.19335/j.cnki.2096-1219.2020.35.014
[16]	王剑, 曹敏. 定坤丹对宫腔粘连患者宫腔镜术后再粘连的预防及相关细胞因子的影响[J]. 湖南中医药大学学报, 2018, 38(8):913-916. doi: 10.3969/j.issn.1674-070X.2018.08.017. doi: 10.3969/j.issn.1674-070X.2018.08.017
[17]	Wu DC, Boyd AS, Wood KJ. Embryonic stem cell transplantation: potential applicability in cell replacement therapy and regenerative medicine[J]. Front Biosci, 2007, 12:4525-4535. doi: 10.2741/2407. doi: 10.2741/2407 URL
[18]	Ding DC, Shyu WC, Lin SZ. Mesenchymal stem cells[J]. Cell Transplant, 2011, 20(1):5-14. doi: 10.3727/096368910X. doi: 10.3727/096368910X URL
[19]	Gargett CE, Ye L. Endometrial reconstruction from stem cells[J]. Fertil Steril, 2012, 98(1):11-20. doi: 10.1016/j.fertnstert.2012.05.004. doi: 10.1016/j.fertnstert.2012.05.004 URL
[20]	Sun H, Lu J, Li B, et al. Partial regeneration of uterine horns in rats through adipose-derived stem cell sheets[J]. Biol Reprod, 2018, 99(5):1057-1069. doi: 10.1093/biolre/ioy121. doi: 10.1093/biolre/ioy121 URL
[21]	Santamaria X, Cabanillas S, Cervelló I, et al. Autologous cell therapy with CD133+ bone marrow-derived stem cells for refractory Asherman′s syndrome and endometrial atrophy: a pilot cohort study[J]. Hum Reprod, 2016, 31(5):1087-1096. doi: 10.1093/humrep/dew042. doi: 10.1093/humrep/dew042 URL
[22]	Ma H, Liu M, Li Y, et al. Intrauterine transplantation of autologous menstrual blood stem cells increases endometrial thickness and pregnancy potential in patients with refractory intrauterine adhesion[J]. J Obstet Gynaecol Res, 2020, 46(11):2347-2355. doi: 10.1111/jog.14449. doi: 10.1111/jog.14449 URL
[23]	Nguyen HP, Simpson RJ, Salamonsen LA, et al. Extracellular Vesicles in the Intrauterine Environment: Challenges and Potential Functions[J]. Biol Reprod, 2016, 95(5):109. doi: 10.1095/biolreprod.116.143503. doi: 10.1095/biolreprod.116.143503 pmid: 27655784
[24]	Zhao S, Qi W, Zheng J, et al. Exosomes Derived from Adipose Mesenchymal Stem Cells Restore Functional Endometrium in a Rat Model of Intrauterine Adhesions[J]. Reprod Sci, 2020, 27(6):1266-1275. doi: 10.1007/s43032-019-00112-6. doi: 10.1007/s43032-019-00112-6 URL
[25]	Saribas GS, Ozogul C, Tiryaki M, et al. Effects of uterus derived mesenchymal stem cells and their exosomes on asherman's syndrome[J]. Acta Histochem, 2020, 122(1):151465. doi: 10.1016/j.acthis.2019.151465. doi: 10.1016/j.acthis.2019.151465 URL
[26]	Liang L, Wang L, Zhou S, et al. Exosomes derived from human umbilical cord mesenchymal stem cells repair injured endometrial epithelial cells[J]. J Assist Reprod Genet, 2020, 37(2):395-403. doi: 10.1007/s10815-019-01687-4. doi: 10.1007/s10815-019-01687-4 URL
[27]	Keshtkar S, Azarpira N, Ghahremani MH. Mesenchymal stem cell-derived extracellular vesicles: novel frontiers in regenerative medicine[J]. Stem Cell Res Ther, 2018, 9(1):63. doi: 10.1186/s13287-018-0791-7. doi: 10.1186/s13287-018-0791-7 pmid: 29523213
[28]	Lv CX, Duan H, Wang S, et al. Exosomes Derived from Human Umbilical Cord Mesenchymal Stem Cells Promote Proliferation of Allogeneic Endometrial Stromal Cells[J]. Reprod Sci, 2020, 27(6):1372-1381. doi: 10.1007/s43032-020-00165-y. doi: 10.1007/s43032-020-00165-y URL
[29]	Amable PR, Carias RB, Teixeira MV, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors[J]. Stem Cell Res Ther, 2013, 4(3):67. doi: 10.1186/scrt218. doi: 10.1186/scrt218 URL
[30]	Foster TE, Puskas BL, Mandelbaum BR, et al. Platelet-rich plasma: from basic science to clinical applications[J]. Am J Sports Med, 2009, 37(11):2259-2272. doi: 10.1177/0363546509349921. doi: 10.1177/0363546509349921 URL
[31]	Segabinazzi L, Canisso IF, Podico G, et al. Intrauterine Blood Plasma Platelet-Therapy Mitigates Persistent Breeding-Induced Endometritis, Reduces Uterine Infections, and Improves Embryo Recovery in Mares[J]. Antibiotics(Basel), 2021, 10(5):490. doi: 10.3390/antibiotics10050490. doi: 10.3390/antibiotics10050490
[32]	Kim JH, Park M, Paek JY, et al. Intrauterine Infusion of Human Platelet-Rich Plasma Improves Endometrial Regeneration and Pregnancy Outcomes in a Murine Model of Asherman′s Syndrome[J]. Front Physiol, 2020, 11:105. doi: 10.3389/fphys.2020.00105. doi: 10.3389/fphys.2020.00105 URL
[33]	Chang Y, Li J, Chen Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization[J]. Int J Clin Exp Med, 2015, 8(1):1286-1290.
[34]	Frantz N, Ferreira M, Kulmann MI, et al. Platelet-Rich plasma as an effective alternative approach for improving endometrial receptivity - a clinical retrospective study[J]. JBRA Assist Reprod, 2020, 24(4):442-446. doi: 10.5935/1518-0557.20200026. doi: 10.5935/1518-0557.20200026
[35]	Li X, Lv HF, Zhao R, et al. Recent developments in bio-scaffold materials as delivery strategies for therapeutics for endometrium regeneration[J]. Mater Today Bio, 2021, 11:100101. doi: 10.1016/j.mtbio.2021.100101. doi: 10.1016/j.mtbio.2021.100101
[36]	Xu B, Cao Y, Zheng Z, et al. Injectable Mesenchymal Stem Cell-Laden Matrigel Microspheres for Endometrium Repair and Regeneration[J]. Adv Biol(Weinh), 2021, 5(8):e2000202. doi: 10.1002/adbi.202000202. doi: 10.1002/adbi.202000202
[37]	Jahanbani Y, Davaran S, Ghahremani-Nasab M, et al. Scaffold-based tissue engineering approaches in treating infertility[J]. Life Sci, 2020, 240:117066. doi: 10.1016/j.lfs.2019.117066. doi: S0024-3205(19)30993-2 pmid: 31738881
[38]	Zhao YX, Chen SR, Huang QY, et al. Repair abilities of mouse autologous adipose-derived stem cells and Shake Gel 3D complex local injection with intrauterine adhesion by BMP7-Smad5 signaling pathway activation[J]. Stem Cell Res Ther, 2021, 12(1):191. doi: 10.1186/s13287-021-02258-0. doi: 10.1186/s13287-021-02258-0 URL
[39]	Xin L, Lin X, Zhou F, et al. A scaffold laden with mesenchymal stem cell-derived exosomes for promoting endometrium regeneration and fertility restoration through macrophage immunomodulation[J]. Acta Biomater, 2020, 113:252-266. doi: 10.1016/j.actbio.2020.06.029. doi: 10.1016/j.actbio.2020.06.029 URL
[40]	Cao Y, Sun H, Zhu H, et al. Allogeneic cell therapy using umbilical cord MSCs on collagen scaffolds for patients with recurrent uterine adhesion: a phase I clinical trial[J]. Stem Cell Res Ther, 2018, 9(1):192. doi: 10.1186/s13287-018-0904-3. doi: 10.1186/s13287-018-0904-3 URL