摘要
目的探讨宫腔镜及子宫内膜浆细胞检查在胚胎种植失败患者中的应用价值。方法回顾性分析2016年9月至2018年4月于贵州省人民医院生殖中心胚胎种植失败并要求再次行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)的患者共239例。根据其在下一周期前是否行宫腔镜及内膜浆细胞检查分为宫腔镜检查组、未行宫腔镜检查组(对照组)两组;并根据其宫腔镜和子宫内膜浆细胞病理检查结果将前者分为正常宫腔组和异常宫腔组。分析宫腔镜检查组患者宫腔镜及浆细胞检查情况,并比较宫腔镜检查组及对照组中再次行IVF者在重复周期中的胚胎着床率及临床妊娠率。结果宫腔镜检查组患者54.29%(57例)宫腔正常,45.71%(48例)发现宫腔异常,其中31.43%(33例)为慢性子宫内膜炎;宫腔镜检查组在重复周期临床妊娠率(39.05%)及胚胎着床率(22.22%)均较对照组(20.15%,11.64%)高,差异有统计学意义(P=0.001,P=0.001)。异常宫腔组患者妊娠率(47.92%)及胚胎着床率(26.42%)虽较正常宫腔组(31.58%,18.49%)增高,但差异无统计学意义(P=0.087,P=0.153)。结论宫腔镜联合子宫内膜浆细胞检查可以发现存在于宫腔内的病变,尤其可以提高子宫内膜炎的检出率;建议胚胎种植失败患者应放宽宫腔镜检查指征,以提高重复周期的临床妊娠率和胚胎着床率。
Objective To investigate the application value of hysteroscopy and endometrial plasmacyte inspection in patients with implantation failure.Methods A total of 239 cases of patients with implantation failure who were planning to undergo IVF-ET treatments in Reproductive Center of Guizhou Provincial People ＇s Hospital from September 2016 to April 2018 were included.According to whether they had hysteroscopy and endometrial plasmacyte examination before the subsequent cycle,patients were divided into two groups：hysteroscopy group and no hysteroscopy group.According to the findings in operation,hysteroscopy group was subdivided into normal uterine group and abnormal uterine group.Pregnancy rate and implantation rate of patients who undergo repeated cycle were compared between these two groups.Results 54.29%（n=57）patients of hysteroscopy group were found with normal uterine cavity,while 45.71%（n=48）with uterine anomalies,31.43% patients with chronic endometritis.Clinical pregnancy rate（39.05%）and implantation rate（22.22%）of patients in hysteroscopy group were higher than those in no hysteroscopy group（20.15%,11.64%）in subsequent cycle,the difference was significantly statistical significant（P=0.001,P=0.001）.While there was not statistical significance in the differences between normal uterine group and abnormal uterine group.Conclusion Hysteroscopy and endometrial plasmacyte examination can detect uterine anomalies,in particular,improve the detection rate of chronic endometritis.Patients with implantation failure are recommended to be conducted with hysteroscopy and endometrial plasmacyte examination to improve the clinical pregnancy rate and embryo implantation rate in subsequent IVF cycle.
作者
耿婷
谭宗建
张栩
GENG Ting;TAN Zong-jian;ZHANG Xu(Guizhou Medical University,Guiyang 550000,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2018年第10期1159-1162,共4页
Chinese Journal of Practical Gynecology and Obstetrics
