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宫腔粘连临床诊疗中国专家共识
中华医学会妇产科学分会
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DOI： 10.3760/cma.j.issn.0529-567X.2015.12.001
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摘要

宫腔粘连（intrauterine adhesions, IUA）是妇科常见、对生育功能严重危害并且治疗效果较差的宫腔疾病，严重影响女性生殖生理及身心健康。继1894年首次发表IUA的文献报道之后，1948年，Asherman详细描述了29例流产或产后刮宫所致IUA病例，并将其定义为"损伤性闭经（traumatical amenorrhea)"，又称为Asherman综合征。目前，IUA在我国的发病率居高不下，并且随着宫腔手术的增加呈逐年增长趋势。文献报道，多次人工流产、刮宫所致的IUA发生率高达25%～30% [ 1 ] ，已经成为月经量减少、继发不孕的主要原因。目前，针对重度IUA尚无有效恢复生育功能和月经生理的治疗方法；宫腔镜宫腔粘连分离术（transcervical resection of adhesion, TCRA）后再粘连率高达62.5% [ 2 ] ，妊娠成功率仅22.5%～33.3% [ 3 , 4 ] 。

引用本文

中华医学会妇产科学分会. 宫腔粘连临床诊疗中国专家共识[J]. 中华妇产科杂志,2015,50(12)：881-887.

DOI:10.3760/cma.j.issn.0529-567X.2015.12.001

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宫腔粘连（intrauterine adhesions, IUA）是妇科常见、对生育功能严重危害并且治疗效果较差的宫腔疾病，严重影响女性生殖生理及身心健康。继1894年首次发表IUA的文献报道之后，1948年，Asherman详细描述了29例流产或产后刮宫所致IUA病例，并将其定义为"损伤性闭经（traumatical amenorrhea)"，又称为Asherman综合征。目前，IUA在我国的发病率居高不下，并且随着宫腔手术的增加呈逐年增长趋势。文献报道，多次人工流产、刮宫所致的IUA发生率高达25%～30% [ 1 ]，已经成为月经量减少、继发不孕的主要原因。目前，针对重度IUA尚无有效恢复生育功能和月经生理的治疗方法；宫腔镜宫腔粘连分离术（transcervical resection of adhesion, TCRA）后再粘连率高达62.5% [ 2 ]，妊娠成功率仅22.5%～33.3% [ 3 , 4 ]。
由于国内对IUA研究的资料有限，缺乏大样本量随机对照试验的研究证据，本共识参考2010年美国妇科腹腔镜医师协会（American Association of Gynecological Laparoscopists, AAGL）发布的关于IUA的临床指南 [ 5 ]，结合我国的具体临床实践，参照加拿大预防保健服务专责小组（Canadian Task Force on Preventive Health Care） [ 6 ]及美国预防保健工作组（US Preventive Services Task Force） [ 7 ]制定的循证医学证据等级，对目前学术界公认的治疗方法进行归纳总结。随着临床诊疗方法的提高和循证医学证据的完善，本共识也将不断修订更新。
本共识中标出的证据等级及推荐等级如下：（1）证据等级：Ⅰ：证据至少来自1个高质量的随机对照研究或荟萃分析；Ⅱa：证据至少来自1个设计严谨的非随机对照研究；Ⅱb：证据至少来自1个设计良好的队列研究（前瞻性或回顾性）或病例对照研究，并且是1个以上研究中心的数据；Ⅱc：证据至少来自1个设计良好的非试验性描述研究，如相关性分析研究、比较性分析研究或病例报告；Ⅲ：基于专家委员会的报告或权威专家的经验。（2）推荐等级：A：有良好和连贯的科学证据支持；B：有限的或不连贯的证据支持；C：主要根据专家共识。
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