宫腔内注射抗结核药物治疗子宫内膜结核的疗效及妊娠结局观察

发布时间：2018-05-27 10:21

本文选题：子宫内膜结核 + 抗结核药　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:探讨宫腔内灌注抗结核药物治疗子宫内膜结核的临床疗效及实施试管婴儿助孕术后的妊娠结局。方法:选取2005年1月至2014年12月就诊于我院生殖中心的不孕症患者,经过系统检查需通过体外受精-胚胎移植术(试管婴儿)助孕的患者中,其中41例患者进行子宫输卵管照影(HSG)检查疑似生殖器结核,并通过宫腔镜检查同时行诊断性刮宫术,刮取子宫内膜组织送病理,病理明确诊断为子宫内膜结核及子宫内膜肉芽肿性炎,并且所有患者均于正规传染病医院筛查为非结核活动期。41例患者依据知情同意及自愿原则分成实验组及对照组。实验组:29例自愿接受宫腔灌注抗结核药治疗子宫内膜结核,治愈后进行体外授精-胚胎移植术(试管婴儿)助孕。对照组:12例自愿接受全身抗结核药治疗子宫内膜结核,治愈后进行试管婴儿助孕。两组患者每治疗一个周期后均行宫腔镜检查同时性诊断性刮宫术复查子宫内膜病理,子宫内膜结核病灶消失者为治疗有效。两组患者中得到有效治疗的患者恢复3次正常月经后行试管婴儿助孕术,并且于胚胎移植术后14天查血HCG大于正常值者为妊娠,胚胎移植术后30天行超声检查提示宫腔内见到妊娠囊,胎芽及胎心搏动为临床妊娠。对两组患者抗结核治疗的有效率、副反应发生率、实施助孕术后的临床结果进行分析。结果:实验组:26例患者治疗后子宫内膜病理提示结核病灶消失,治愈率为89.66%治疗过程中有3例患者出现了轻微的副反应。实施试管婴儿助孕术后8例临床妊娠,临床妊娠比率为30.76%。1例胚胎移植术后17天血HCG值下降,胚胎移植术后25天恢复月经为生化妊娠。1例胚胎移植术后30天复查彩超提示异位妊娠而行腹腔镜手术。其余7例为宫内妊娠状态良好。对照组:9例患者子宫内膜病理提示结核病灶消失,治愈率为75%。治疗过程中7例患者出现了不同程度的副反应,其中2例患者出现了较重的副反应。实施试管婴儿助孕术后2例妊娠,妊娠率为22.22%。胚胎移植术后30天复查彩超均为宫内妊娠状态良好。结论:宫腔内灌注抗结核药物能有效治疗子宫内膜结核,副反应发生率低且程度轻。可使子宫内膜结核患者获得更多的实施试管婴儿助孕术的机会。
[Abstract]:Objective: To investigate the clinical efficacy of intrauterine antituberculous drugs in the treatment of endometrial tuberculosis and to implement the outcome of pregnancy after a test tube baby. Methods: to select the infertility patients in the reproductive center of our hospital from January 2005 to December 2014. After systematic examination, the patients who had to be assisted by in vitro fertilization embryo transfer (test tube baby) were selected. Among the 41 patients, 41 patients underwent uterine tubal illumination (HSG) to examine the suspected genital tuberculosis, and by hysteroscopy, diagnostic curettage was performed at the same time, and the endometrium tissue was removed for pathology. The pathological diagnosis was endometrial tuberculosis and endometrial granulomatous inflammation, and all patients were screened in regular infectious disease hospitals. .41 patients in the period of tuberculosis were divided into experimental group and control group according to informed consent and voluntary principle. Experimental group: 29 cases were treated voluntarily by intrauterine instillation of anti tuberculosis drugs to treat endometrium tuberculosis, and after cured in vitro fertilization and embryo transfer (test tube infant) assisted pregnancy. Control group: 12 cases voluntarily received systemic antituberculous drugs for endometrial tuberculosis, After one period of treatment, the two groups of patients were treated with hysteroscopy and diagnostic curettage after each period of treatment, and the endometrium pathology was rechecked. The patients with endometrium nodule disappearance were treated effectively. The two groups of patients received effective treatment recovered 3 times of normal month after tube baby assisted pregnancy, and in the embryo. 14 days after transplantation, the HCG was more than the normal value of pregnancy. 30 days after the embryo transfer, ultrasound examination suggested that the pregnancy sac, fetal bud and fetal heart beat were clinical pregnancy. The effective rate of anti tuberculosis treatment and the incidence of side effects in two groups were analyzed. Results: in the experimental group, 26 patients were treated. After the treatment, the pathology of endometrium showed that the tuberculosis focus disappeared, and 3 patients had minor side effects during the cure rate of 89.66%. 8 cases of clinical pregnancy after the test tube baby assisted pregnancy were carried out. The rate of clinical pregnancy was 17 days after 30.76%.1 embryo transfer, and the decrease of blood HCG value and the recovery of menstruation to.1 embryoid embryos at 25 days after the embryo transfer operation. Laparoscopy was performed on 30 days after fetal transplantation. The other 7 cases were in good state of intrauterine pregnancy. The control group: 9 cases of endometrium pathology suggested that the tuberculosis lesions disappeared, the cure rate was 7 patients in the course of 75%. treatment, with different degree of side effects, of which 2 patients had a heavier side reaction. 2 cases of pregnancy after the test tube baby assisted pregnancy, the pregnancy rate was 30 days after the 22.22%. embryo transfer, the color Doppler ultrasound was all in the state of intrauterine pregnancy. Conclusion: intrauterine infusion of anti tuberculosis drugs can effectively treat endometrial tuberculosis, the incidence of side effects is low and light. Opportunity.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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