宫腔镜子宫内膜息肉电切术后胚胎移植合适时间的探讨

发布时间：2018-12-15 10:25

【摘要】：研究背景：随着宫腔镜检查技术在人类辅助生殖技术中的广泛应用,越来越多的不孕症患者被检出子宫内膜息肉。子宫内膜息肉的发病机制仍不明确,主要有以下几个推断：高表达的雌激素受体使子宫内膜过过增生,形成息肉；雌激素合成限速酶芳香化酶P450局部过度表达,使局部雌激素水平过高；血管内皮生长因子(VEGF)、转化生长因子(TGF)和胰岛素样生长因子在子宫内膜息肉组织中的高表达；子宫内膜局部组织细胞凋亡基因的过多表达导致局部内膜细胞凋亡障碍,不能如期脱落;遗传物质异常。而子宫内膜息肉导致不孕可能通过不规则子宫出血、长期子宫内膜慢性炎症反应、改变胚胎植入所需的微环境、阻碍精卵相遇、干扰胚胎着床等。子宫输卵管碘油造影、B超、诊断性刮宫、宫腔镜检查等都可以为子宫内膜息肉的诊断提供线索,而宫腔镜检查及对可疑病变直视下活检成为诊断的金标准。宫腔镜下子宫内膜息肉电切术是目前最好的处理办法。对于即将行胚胎移植的不孕症患者行息肉电切术可以显著提高体外受精-胚胎移植即试管婴儿的成功率。研究表明子宫内膜局部的机械损伤诱导的炎症反应可以介导子宫内膜容受性的增加,提高妊娠率,但是在宫腔镜下息肉电切术后对子宫内膜造成电损伤是否能达到相同效果,而什么时间适合行胚胎移植才能获得最满意的IVF妊娠率,目前仍没有相关研究。研究目的：对于接受宫腔镜下子宫内膜息肉电切术的患者,探讨术后最佳的移植时间以获得最高的IVF-ET成功率。研究方法：回顾性分析2012年1月-2012年12月于我院宫腔镜电切术后接受胚胎移植的321例患者,所有患者的息肉组织都进行了病理检测,将患者分成3组,第1组(G1)于术后1个月时移植(47例),第2组(G2)于术后2个月时移植(134例),第3组(G3)于术后3个月及3个月以上移植(140例),比较3组的妊娠结局。结果：共321例接受宫腔镜下子宫内膜息肉电切术后行胚胎移植,其妊娠结果是：G1临床妊娠31例,生化妊娠1例,自然流产5例,活产24例；G2临床妊娠77例,生化妊娠4例,自然流产8例,活产68例；G3临床妊娠29例,生化妊娠9例,自然流产5例,活产72例。其临床妊娠率分别为66%、57.5%、56.4%,活产率分别为51.1%、50.7%、51.4%,生化妊娠率2.1%、3%、6.4%,自然流产率分别为10.6%、6%、3.6%。3组的妊娠结局之间无显著差异性(P0.1)。结论：接受宫腔镜下子宫内膜息肉切除术的不孕症患者,可根据患者的实际情况在术后1个月后任意选择适合的胚胎移植时间。
[Abstract]:Background: with the wide application of hysteroscopy in human assisted reproduction, more and more infertility patients have been detected endometrial polyps. The pathogenesis of endometrial polyps is still unclear, mainly as follows: high expression of estrogen receptor makes endometrial hyperplasia, forming polyps; The local overexpression of estrogen synthesis rate-limiting enzyme aromatase P450 made the local estrogen level too high, the expression of vascular endothelial growth factor (VEGF), transforming growth factor (TGF) and insulin like growth factor in endometrial polyps was high. Overexpression of apoptotic genes in local endometrial tissues leads to the obstruction of apoptosis of local endometrial cells and the abscission of genetic material. Endometrial polyps may lead to infertility through irregular uterine bleeding, chronic endometrial inflammation, change the microenvironment needed for embryo implantation, hinder the meeting of sperm and eggs, interfere with embryo implantation, and so on. Hysterosalpingography, B-ultrasound, diagnostic curettage and hysteroscopy can all provide clues for the diagnosis of endometrial polyps. Hysteroscopy and biopsy of suspected lesions are the golden criteria for diagnosis of endometrial polyps. Hysteroscopic resection of endometrial polyps is the best treatment at present. Polyp electrotomy for infertile patients undergoing embryo transfer can significantly improve the success rate of in vitro fertilization and embryo transfer (IVF). Studies have shown that the inflammatory response induced by local mechanical injury of endometrium can mediate increased endometrial receptivity and increase pregnancy rate, but whether the same effect can be achieved after electroresection of polyps under hysteroscopy. No studies have been conducted on the timing of embryo transfer to achieve the most satisfactory IVF pregnancy rate. Objective: to investigate the best time of transplantation for patients undergoing hysteroscopic resection of endometrial polyps in order to obtain the highest success rate of IVF-ET. Methods: from January 2012 to December 2012, 321 patients received embryo transfer after hysteroscopic resection in our hospital were retrospectively analyzed. The polyps of all patients were examined by pathology and divided into 3 groups. Group 1 (G1) was transplanted at 1 month (47 cases), group 2 (G2) was transplanted at 2 months (134 cases), group 3 (G3) was transplanted 3 months and more than 3 months after operation (140 cases). Results: a total of 321 cases received hysteroscopic resection of endometrial polyps for embryo transfer. The results of pregnancy were as follows: 31 cases of G1 clinical pregnancy, 1 case of biochemical pregnancy, 5 cases of spontaneous abortion and 24 cases of live delivery. There were 77 cases of G2 clinical pregnancy, 4 cases of biochemical pregnancy, 8 cases of spontaneous abortion, 68 cases of live delivery, 29 cases of G3 clinical pregnancy, 9 cases of biochemical pregnancy, 5 cases of spontaneous abortion and 72 cases of live delivery. The clinical pregnancy rates were 66% 57.5% and 56.4% respectively, the live birth rates were 51.1% and 50.7%, 51.4%, the biochemical pregnancy rate 2.1% and 6.4%, and the natural abortion rate 10.6%, respectively. There was no significant difference in pregnancy outcome between the three groups (P 0.1). Conclusion: infertile patients undergoing hysteroscopic resection of endometrial polyps may choose the appropriate embryo transfer time one month after operation according to the actual situation of the patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

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