经阴道超声对促排卵患者子宫内膜容受性的评价

发布时间：2018-04-26 03:31

  本文选题：子宫内膜容受性 + 阴道超声　； 参考：《山东大学》2014年硕士论文

【摘要】：研究背景 世界卫生组织宣布将不孕症与心血管病、肿瘤病列为影响当今人类生活和健康的三大主要疾病。因此科研人员也越来越重视对不孕不育症的研究和治疗,但是不论哪种治疗方法,治疗的关键因素还是取决于优质的胚胎和良好的子宫内膜容受性以及两者间的相互应答。现代医学对于子宫内膜容受性的研究越来越受到重视,已经成为世界生殖医学系统研究的焦点。无论是研究还是改善内膜容受性,都需要对内膜容受性有良好的评价指标。虽然现在判断内膜容受性的金标准是子宫内膜活检,但因其是一种有创性的检查,很大程度上限制了其在临床的应用。超声检查作为一种直观、简便、无创及可重复性强的评价方式,有极强的临床应用价值,越来越受到推崇。相关专业人员利用超声多普勒功能对影响子宫内膜容受性的多个参数进行研究。 目的 经阴道超声利用二维灰阶、彩色多普勒、能量多普勒技术,观测促排卵治疗不孕患者子宫内膜厚度、形态特征,子宫动脉RI及PI指数、子宫内膜下血流分布等参数来评价不孕症患者子宫内膜容受性。资料与方法； 2013年3月-2013年12月于我院临床接受促排卵治疗的98例不孕症患者,采用CC/HmG/HCG促排卵方案,选择HCG注射日进行阴道超声检查,观察子宫及卵巢的大小、形态,于子宫正中矢状切面测量子宫内膜厚度,观察内膜形态,测量有优势卵泡侧子宫动脉PI及RI,利用能量多普勒观察内膜下血流分布。根据测量内膜厚度分为3组：(1)7mm组；(2)7-14mm组;(3)14mm组。内膜形态按照Gonen[1]等人的超声下内膜形态学分类法,对不孕患者的内膜形态进行分型：分为A型,典型三线型或多层子宫内膜,即两外层线和中央线为强回声线,两外层线与宫腔中线之间为低回声区或暗区；B型,为均匀的中等强度回声型,宫腔内强回声中央线可见但断续；C型,内膜为均质的强回声,宫腔中线回声显示不清。根据内膜厚度分组及内膜形态分型情况对临床妊娠率进行综合分析。根据测量所得的子宫动脉PI及RI值与妊娠率进行分析。能量多普勒下对内膜下血流分布进行分型,分型标准采用Applehau[2]分型法,I型：见血流信号穿过内膜外侧低回声带,但未达到内膜高回声外边缘；Ⅱ型：见血流信号穿过内膜高回声外边缘,但未进入内膜低回声区；Ⅲ型：见血流信号进入内膜低回声区。按妊娠与否分为两组,进行统计学分析,比较两组间各项参数有无统计学差异。 结果： 98名患者经促排卵治疗后,33名患者妊娠,妊娠率为33.67%。妊娠组与非妊娠组患者一般情况比较差异无统计学意义。妊娠组患者内膜厚度为10.56±2.11mm,非妊娠组患者内膜厚度为9.34±2.57mm,两组间差异有统计学意义。按内膜厚度分组1组中15名患者无妊娠者,2组妊娠率为39.68%,3组妊娠率为40%,各组间差异有统计学意义；内膜形态分组为A型组妊娠率为51.2%,B型组妊娠率为22.5%,C型组妊娠率为17.6%,各组间差异有统计学意义；内膜厚度与形态综合比较2组及3组中由A型向C型妊娠率逐渐降低,内膜厚度一定时,A型内膜妊娠率高；子宫动脉妊娠组PI为2.23±0.42,RI为0.71±0.15,非妊娠组PI为2.45±0.35,R1O.85±0.13,妊娠组与非妊娠组差异有统计学意义；能量多普勒观察子宫内膜下血流分型,I型组妊娠率为23.8%,II型组妊娠率为26.5%,III组妊娠率为53.6%,III型组与I型组与II型组比较差异具有统计学意义,I组与II组间差异没有统计学意义。 结论： 在不孕症促排卵治疗中,于HCG注射日经阴道超声观察内膜形态,测量子宫内膜厚度及子宫动脉血流指数,能量多普勒观察内膜下血流分布能够作为评价子宫内膜容受性的指标,对临床不孕症的治疗有较好的指导意义,可以有效提高不孕症促排卵治疗的成功率。
[Abstract]:Research background
The WHO announced that infertility, cardiovascular disease, and cancer are the three major diseases that affect human life and health. Therefore, researchers are paying more and more attention to the study and treatment of infertility. However, no matter which treatment, the key factors for treatment depend on the quality of the embryo and in the good uterus. Membrane receptivity and the mutual response between the two are becoming more and more important in the study of endometrial receptivity. It has become the focus of the research in the world reproductive medicine system. Both research and improvement of endometrial receptivity require a good evaluation index for endometrial receptivity. Although gold is now judged to be tolerant of endometrium The standard is endometrial biopsy, but because it is a invasive examination, it restricts its clinical application to a large extent. Ultrasound examination is an intuitive, simple, noninvasive and repeatable evaluation method. It has a strong clinical value and is becoming more and more admired. The related professionals use the ultrasonic Doppler function to influence the children. Multiple parameters of endometrium receptivity were studied.
objective
The endometrium receptivity of infertile patients was evaluated by using two-dimensional gray scale, color Doppler and energy Doppler technique by transvaginal ultrasound. The endometrium thickness, morphological characteristics, RI and PI index of uterine artery and the distribution of the endometrium blood flow were measured to evaluate the endometrium receptivity of infertile patients.
In December -2013 March 2013, 98 cases of infertility treated with ovulation induction in our hospital, using CC/HmG/HCG to promote ovulation, selected HCG injection day for vaginal ultrasound examination, observed the size and shape of uterus and ovary, measured the endometrium thickness, observed the morphology of the endometrium, and measured the dominant follicle lateral uterus in the median sagittal section of the uterus. Artery PI and RI, using energy Doppler to observe the subintimal blood flow distribution. According to the thickness of the measured intima, there were 3 groups: (1) 7mm group; (2) 7-14mm group; (3) 14mm group. The endometrium morphology of infertile patients was classified according to Gonen[1] et al morphology classification: A type, typical three linear or multi-layer endometrium, The two outer line and the central line are strong echo lines, the two outer line and the middle line of the uterine cavity are hypoechoic or dark areas; B type is a homogeneous medium echo type, the intrauterine strong echo central line is visible but intermittent; C type, the endometrium is homogeneous strong echo, the middle line echo of the uterine cavity is not clear. According to the intimal thickness grouping and intima morphological classification feeling A comprehensive analysis of the clinical pregnancy rate was carried out. According to the measured PI and RI values of the uterine artery and the pregnancy rate, the distribution of the subintimal blood flow was classified under the energy Doppler. The classification standard was made by the Applehau[2] typing, I type: the blood flow signal passed through the inner intimal hypoechoic band, but did not reach the hyperechoic outer edge of the intima; II Type: see the blood flow signal through the hyperechoic outer edge of the endometrium, but did not enter the endometrium hypoechoic region; type III: see the blood flow signal into the endometrium hypoechoic region. According to pregnancy or not, the two groups were statistically analyzed, and there were no statistical differences between the two groups.
Result锛，

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