[Current status of intrauterine adhesion treatment and research progress in stem cell therapy].

内容摘要

Intrauterine adhesions (IUA) are gynecological disorders mainly characterized by menstrual abnormalities and infertility. At present, hysteroscopic adhesiolysis is the primary treatment for IUA; however, the postoperative recurrence rate remains high in patients with moderate to severe disease. In clinical practice, postoperative adjuvant therapies, including pharmacological treatment and intrauterine placement of physical barriers, are commonly applied to promote endometrial regeneration and reduce the risk of re-adhesion. These approaches show certain efficacy in patients with mild IUA, but their effects on restoring endometrial structure and improving pregnancy outcomes in moderate to severe cases remain limited. In recent years, stem cell therapy has demonstrated promising potential in endometrial repair, among which mesenchymal stem cells (MSCs) are considered the stem cell type with the greatest potential for clinical translation. MSCs can not only participate in tissue regeneration through differentiating into endometrial-related cells, but also exert indirect reparative effects through the secretion of extracellular vesicles (EVs), including anti-inflammatory, immunomodulatory, anti-fibrotic, pro-proliferative, and pro-angiogenic activities, thereby effectively promoting endometrial regeneration and improving pregnancy outcomes. However, most existing studies remain at the basic research or early clinical stage, and current clinical evidence is still insufficient. Their precise mechanisms of action and optimal application strategies also require further clarification. Future studies should focus on identifying potential therapeutic targets, systematically elucidating the mechanisms by which MSCs and their EVs contribute to IUA treatment, and promoting the standardized clinical translation of related research, with the ultimate goal of providing more effective therapeutic strategies for improving the endometrial environment and female reproductive function. 宫腔粘连(intrauterine adhesions，IUA)是以月经异常和不孕为主要临床表现的妇科疾病。目前，宫腔镜下粘连分离术是IUA的主要治疗手段，但中重度患者术后复发率仍较高。临床上常于术后辅以药物治疗、宫内放置物理屏障等措施，以期促进子宫内膜再生、降低再粘连风险。上述方法对轻度IUA患者具有一定疗效，但对中重度患者的子宫内膜结构恢复及妊娠结局改善效果仍较为有限。近年来，干细胞疗法在修复子宫内膜方面展现出良好的应用前景，其中，间充质干细胞(mesenchymal stem cells，MSCs)被认为是最具临床转化潜力的干细胞类型。MSCs不仅可通过分化为子宫内膜相关细胞参与组织再生，还可通过分泌胞外囊泡(extracellular vesicles，EVs)等发挥抗炎、免疫调节、抗纤维化、促进子宫内膜细胞增殖及血管再生等间接修复作用，从而有效促进子宫内膜再生并改善妊娠结局。然而，现有研究多处于基础或早期临床阶段，相关临床证据尚不充分，其具体作用机制及最佳应用方式仍有待进一步明确。未来需深入挖掘潜在治疗靶点，系统阐明MSCs及其EVs在IUA治疗中的作用机制，并推动相关研究向规范化临床转化，以期为改善子宫内膜环境及女性生殖功能提供更加有效的治疗策略。.