宫腔镜子宫内膜微创术对子宫内膜容受性影响的研究  

Influence of Endometrium Minimally Invasive Surgery by Hysteroscopy on Endometrial Receptivity

作　　者：覃桂荣[1] 熊艳敏[2] 李柳铭 

机构地区：[1]广西医科大学第一附属医院,广西南宁530021 [2]广西医科大学第一临床医学院,广西南宁530021

出　　处：《实用妇产科杂志》2014年第2期128-131,共4页Journal of Practical Obstetrics and Gynecology

基　　金：广西壮族自治区卫生厅自筹经费科研课题(编号:Z2011338)

摘　　要：目的:探讨宫腔镜下子宫内膜微创术对子宫内膜容受性的影响。方法:选择2011年11月至2012年9月在广西医科大学第一附属医院生殖中心行体外受精-胚胎移植反复失败2次及以上且子宫内膜相对薄弱的患者20例行宫腔镜子宫内膜微创术,于术前和术后1月,在月经黄体中、后期对采用高分辨率经阴道多普勒超声观察子宫内膜厚度、分型及血流参数和能量多普勒血流显像(PDI)血流分型,术中和术后1月宫腔镜下进行子宫内膜形态学分型及电镜下观察胞饮突情况,并统计术后随访半年妊娠率。结果:①B超检查结果:术后1月子宫内膜的厚度、搏动指数(PI)均较术前明显提高(P=0.020;P=0.000),阻力指数(RI)明显降低(P=0.000);术后子宫内膜分型以三线型和高回声型为主,与术前比较,差异有统计学意义(P=0.011);PDI血流分型也以Ⅱ型、Ⅲ型为主,与术前比较,差异有统计学意义(P=0.019)。②术后宫腔镜下子宫内膜形态学分型为佳型的比例(80%)高于术前(40%),差异有统计学意义(P=0.014)。③扫描电镜下观察,术后子宫内膜胞饮突数目(3.80±1.05)高于术前(1.60±0.75),术后完全发育胞饮突所占比例(65%)高于术前(20%),差异均有统计学意义(P=0.043;P=0.035)。结论:经宫腔镜子宫内膜微创术可改善子宫内膜的分型及血流分布情况、增加佳型子宫内膜、改善子宫内膜胞饮突的发育,提高子宫内膜容受性。Objective ：To study the influence of endometrium minimally invasive surgery on endometrial re- ceptivity. Methods：20 cases whose endometria were relatively weak and had failed 2 times or more in vitro fertilization and embryo transplantation in the reproductive center of our hospital from November,2011 to September,2012 were included as study group. In one month before and after surgery,the endometrial thick- ness, classification, blood flow parameters and power doppler imaging （PDI）blood flow classification were e- valuated by high resolution by transvaginal Doppler ultrasound in menstrual corpus luteum mid to late period; during and one month after surgery,the classification of endometrial morphology by Hysteroscopic and the observation of condition of pinopodes by electron microscopy were conducted,and postoperative follow-up for half a year to count the pregnancy rate. Results：~The results of B ultrasonic showed that：after one month of minimally invasive surgery,the thickness of the endometria and PI were significantly improved compared with those of preoperative（ P = 0. 020;P = 0. 000）, R I is decreased significantly（ P = 0. 000） ;The endometrial classifications were mainly three linear and high echo ,compared with those of preoperative, statistically signif- icant difference was found（ P=0.011 ）. PDI were mainly Type 1] and Type 1I ,compared with those of preop- erative, statistically significant difference was found （ P = 0. 019） ;~The proportion of beautiful type endometri- um（80%） after minimally invasive was more than that of preoperative（40%）, statistically significant differ- ence was found （ P = 0. 014） ; Observed under SEM, the number of postoperative endometrial pinopodes（3.80 ＋ 1.05）was more than that of preoperative（1.60 - O. 75） ,the postoperative proportion of fully devel- oped pinopodes （65%） was more than that of preoperative （20%）, statistically significant difference was found（ P=O. 043;P = O. 035）. Conclusions. The minimally inv

关 键 词：子宫内膜 容受性 微创手术 宫腔镜 B超 电镜 

分 类 号：R711.6[医药卫生—妇产科学]