体外受精-胚胎移植术有助于提高宫腔粘连分离术后患者的活产率  

In vitro fertilization and embryo transfer may improve live birth rate for patients with intrauterine adhesions after hysteroscopic adhesiolysis

作　　者：孙丹 赵行平[1] 黄欢 张爱倩[1] 程文炜 杨益民 徐大宝[1] SUN Dan;ZHAO Xingping;HUANG Huan;ZHANG Aiqian;CHENG Wenwei;YANG Yimin;XU Dabao(Department of Gynecology,Third Xiangya Hospital,Central South University,Changsha,410013;Department of Gynecology and Obstetrics,First Affiliated Hospital,Guangxi Medical University,Nanning 530021;Department of Medical Administration,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院妇科,长沙410013 [2]广西医科大学第一附属医院妇科,南宁530021 [3]中南大学湘雅三医院医务部,长沙410013

出　　处：《中南大学学报（医学版）》2022年第11期1559-1567,共9页Journal of Central South University ：Medical Science

基　　金：国家重点研发计划(2018YFC1004800);湖南省科技计划项目(2021SK53704,2020SK53605)。

摘　　要：目的:宫腔粘连(intrauterine adhesion,IUA)的患病率逐渐增加,严重影响女性生殖健康和生育能力。本研究主要探讨影响IUA患者术后活产率的因素。方法:共纳入486名于2017年1月至2018年5月在中南大学湘雅三医院行宫腔镜下宫腔粘连分离术(hysteroscopic adhesiolysis,HA)且有生育需求的IUA患者。术后随访2年。分析的术前临床指标包括:妊娠方式、年龄、妊娠次数、分娩次数、流产次数、是否为复发性IUA为末次宫深、末次宫角或输卵管口是否可见、末次美国生育协会(American Fertility Society,AFS)评分。通过单因素分析和多因素logistic回归分析探讨各临床指标与术后活产率的关系,以妊娠方式为主变量。结果:共256人(52.67%)活产,230人(47.33%)非活产。Logistic回归分析发现IUA术后选择体外受精-胚胎移植术(in vitro fertilization and embryo transfer,IVF-ET)助孕较自然妊娠活产率更高(OR=0.557,95%CI:0.361~0.861,P=0.008);末次手术双侧输卵管口可见,更有可能活产(OR=0.322,95%CI:0.104~0.997,P=0.049);年龄增大(OR=1.081,95%CI:1.034~1.131,P<0.001),末次AFS评分中度(OR=2.973,95%CI:1.541~5.738,P<0.010)活产率较低。结论:IVF-ET、年龄、末次双侧输卵管口是否可见、末次AFS评分是影响HA术后活产率的预测因素。IVF-ET可能提高患者HA术后的活产率。Objective:The prevalence of intrauterine adhesion(IUA)increased gradually,which seriously affected female reproductive health and fertility.This study aims to analyze the clinical features of pre-,intra-,and post hysteroscopic adhesiolysis(HA)and to identify the main risk factors for non-live birth and other factors affecting pregnancy outcome in patients with IUA.Methods:A total of 486 IUA patients with reproductive needs,who underwent HA in the third Xiangya Hospital of Central South University from January 2017 to May 2018,were retrospectively included.The follow-up period was 2−3 years after operation.Univariate analysis and multivariate logistic regression analysis were used to explore the relationship between clinical features and live birth rate in patients with IUA.Pre-operative clinical indicators included age,gravidity,parity,abortion,IUA recurrence,menstrual patterns,and disease course.Intraoperative clinical features assessed in the last operation were uterine cavity length,IUA appearance,IUA area,number of visible uterine cornua,number of visible tubal ostia,and American Fertility Society(AFS)scores.The relationship between clinical indicators and postoperative live birth rate was investigated by univariate analysis and multivariate logistic regression analysis.Pregnancy pattern was the main variable.Results:Among the 486 IUA patients included in this study,there were 256(52.67%)live births and 230(47.33%)non-live births.Univariate analysis and multivariate logistic regression showed that the live birth rate of in vitro fertilization and embryo transfer(IVFET)after HA was higher than that of spontaneous pregnancy(OR=0.557,95%CI 0.361 to 0.861,P=0.008).When the bilaterally fallopian tube ostia were invisible in the last operation(OR=0.322,95%CI 0.104 to 0.997,P=0.049),patients were more likely to have live birth.The older the patient was,the lower the live birth rate was(OR=1.081,95%CI 1.034 to 1.131,P<0.001).The live birth rate would be low when the last AFS score was moderate(OR=2.973,95%CI to 1.5

关 键 词：宫腔粘连 预后 活产率 宫腔粘连分离术 体外受精-胚胎移植术 

分 类 号：R714.8[医药卫生—妇产科学]