Abstract
Intrauterine adhesion (IUA) is a common gynaecological disease that develops from infection or trauma. IUA disease may seriously affect the physical and mental health of women of childbearing age, which may lead to symptoms such as hypomenorrhea or infertility. Presently, hysteroscopic transcervical resection of adhesion (TCRA) is the principal therapy for IUAs, although its function in preventing the recurrence of adhesion and preserving fertility is limited. Pharmaceuticals such as hormones and vasoactive agents and the placement of nondegradable stents are the most common postoperative adjuvant therapy methods. However, the repair of injured endometrium is relatively restricted due to the different anatomical structures of the endometrium. Recently, the treatment outcome of IUAs has improved with the advancement of hysteroscopic techniques. In particular, the application of bioactive scaffolds combined with tissue engineering technology has proven to have high therapeutic potential or endometrial repair in IUA treatment. Herein, this review has summarized past therapeutic strategies, including postoperative adjuvant therapy, cell or therapeutic molecular delivery therapy methods and bioactive scaffold-based tissue engineering methods. Therefore, this review presented the recent therapeutic strategies for repairing endometrium treatment and pointed out the issues of clinical concern to provide alternative methods for the management of IUAs.
Highlights
Intrauterine adhesion (IUA), known as Asherman’s syndrome (AS), refers to endometrial injury induced by infection (Fig. 1A), trauma (Fig. 1B) and other reasons
Hysteroscopy has evolved into the gold standard for the diagnosis of IUAs by virtue of its accuracy and intuitiveness, and transcervical resection of adhesion (TCRA) is the first choice for the treatment of IUAs, supplemented by hormones and other medications to improve menstrual volume
Previous studies have pointed out the promising roles of bioactive materials in enhancing endometrial healing and fertility outcomes
Summary
Intrauterine adhesion (IUA), known as Asherman’s syndrome (AS), refers to endometrial injury induced by infection (Fig. 1A), trauma (Fig. 1B) and other reasons. The standard clinical treatment scheme for IUAs is adhesiolysis under direct hysteroscopic visualization [5], and transcervical resection of adhesion (TCRA) (Fig. 1D) is the preferred surgical method for treating IUAs due to its perceptual intuition, accuracy and minimal invasion. It should be operated on under ultrasonic or laparoscopic monitoring to avoid perforation if necessary [6]. How to prevent postoperative adhesion in IUA patients and how to promote damaged endometrial regeneration to improve reproductive outcomes are the most urgent problems to be solved.
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