摘要
目的:探讨冷器械联合周期性球囊扩张术治疗宫腔粘连(IUA)在体外受精-胚胎移植(IVF-ET)中的临床效果。方法:对175例经宫腔镜检查确诊为IUA的患者行冷刀分离粘连,术后继续每间隔1周进行球囊扩张术并联合雌、孕激素人工周期治疗。治疗后行冻融胚胎移植。比较IUA轻度组(95例)、中度组(65例)及重度组(15例)患者的一般情况及临床结局。结果:(1)3组患者治疗后子宫内膜厚度均比治疗前增厚(P<0.01),3组治疗前后子宫内膜厚度的差值比较,差异有统计学意义(P<0.05),重度IUA组子宫内膜的差值最大。(2)治疗后,共有163例(93.14%)患者恢复正常宫腔形态,12例患者行再次IUA分离术,其中轻度IUA组(97.89%)和中度IUA组(93.89%)宫腔形态恢复正常的比例显著高于重度IUA组(60.00%);轻度IUA组月经恢复正常的比例(84.21%)高于中度IUA组(66.15%)和重度IUA组(33.33%)。(3)人工替代周期准备内膜并行冻融胚胎移植后整体临床妊娠率为54.29%(95/175),继续妊娠率为40.00%(70/175)。3组间移植胚胎数目、胚胎类型、胚胎种植率、临床妊娠率、继续妊娠率、早期流产率及异位妊娠率差异均无统计学意义(P>0.05)。结论:宫腔镜下冷刀联合周期性球囊扩张术有利于子宫内膜的改善,对于IVF助孕合并宫腔粘连的女性有一定的临床效果,尤其是轻度粘连者可能效果更佳。
Objective:To investigate the clinical effect of hysteroscopic adhesiolysis combined with periodic balloon dilation in the treatment of intrauterine adhesions(IUA)during in vitro fertilization and embryo transfer(IVF-ET).Methods:A total of 175 patients diagnosed with IUA by hysteroscopy were treated with intrauterine scissors to separate the adhesions,followed by balloon dilation every one week after surgery,combined with artificial cycles of estrogen and progesterone.Frozen embryo transfer was performed after treatment.The general characteristics and clinical outcomes of patients with mild group(95 cases),moderate group(65 cases)and severe group(15 cases)were compared.Results:(1)The endometrial thickness after treatment was obviously thicker than before in the three groups(P<0.01).The endometrial changes before and after treatment was statistically significant(P<0.05),and the change was most obvious in the severe IUA group.(2)After treatment,a total of 163 patients(93.14%)returned to normal intrauterine morphology,and 12 patients underwent IUA separation again.The proportion of normal intrauterine morphology in mild IUA group(97.89%)and moderate IUA group(93.89%)were significantly higher than that in severe IUA group(60.00%).The proportion of menorrhagia returning to normal in mild IUA group(84.21%)was higher than that in moderate IUA group(66.15%)and severe IUA group(33.33%).(3)The overall clinical pregnancy rate after preparation of endometrium by artificial replacement cycle and frozen-thawed embryo transfer was 54.29%(95/175),and the continued pregnancy rate was 40.00%(70/175).There were no significant differences in the number of transferred embryos,embryo type(cleavage embryo or blastocyst),implantation rate,clinical pregnancy rate,ongoing pregnancy rate,early abortion rate and ectopic pregnancy rate among the three groups(P>0.05).Conclusions:Hysteroscopic adhesiolysis combined with periodic balloon dilation is beneficial to the improvement of the endometrium,and has a certain clinical effect on women with IVF complicated with intrauterine adhesions,especially those with mild adhesions.
作者
赵艳
陈圆辉
高云
张翠莲
ZHAO Yan;CHEN Yuanhui;GAO Yun(Reproductive Medicine Center,Henan Provincial People's Hospital,Zhengzhou Henan 450003,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2022年第10期754-758,共5页
Journal of Practical Obstetrics and Gynecology
基金
国家重点研发计划课题(编号:2018YFC1002106)。
关键词
宫腔粘连
冷刀分离术
球囊扩张
胚胎移植
Intrauterine adhesions
Hysteroscopic adhesiolysis
Balloon dilation
Embryo transfer
作者简介
通讯作者:张翠莲,E-mail:luckyzcl@qq.com。
