宫腔镜手术对子宫内膜容受性相关指标的影响

目的 分析宫腔镜下子宫内膜微创术对子宫内膜容受性(EP)相关指标的影响。方法 选取2017年1月至2018 年1月于某院妇科就诊的不孕症患者20例,于宫腔镜下观察子宫内膜形态、收集子宫内膜标本并实施子宫内膜微创术。术后第1、2个月再次实施宫腔镜子宫内膜微创术,于术后3个月的种植窗期返院收集子宫内膜标本。比较术前、术后3月EP生化指标的变化。通过HE染色,光学显微镜下观察子宫内膜的分泌情况。运用免疫组化链霉菌抗生物素蛋白-过氧化酶连接(SP)法定位及半定量检测子宫内膜雌激素受体(ER)、孕激素受体(PR)、白血病抑制因子( LIF)、血管内皮生长因子( VEGF)表达情况,分析患者种植窗期血清雌激素(E₂) 及孕激素(P)水平,并对患者行胚胎移植、跟踪随访其着床率以及妊娠率。结果 宫腔镜下子宫内膜微创术治疗后患者血清E₂、P水平稍高于术前,但差异无统计学意义,术后子宫内膜ER、PR、VEGF表达水平较术前明显提高,P＜0.05或＜0.01,术后患者再次进行体外受精-胚胎移植术(IVF-ET)着床率为45%,临床妊娠率为35%。结论 宫腔镜子宫内膜微创术能够显著改善EP,提高种植窗期子宫内膜ER、PR、VEGF表达水平,以及IVF-ET着床率和临床妊娠率。

Effect of hysteroscopic surgery on relative indicators of endometrial receptivity

Objective To analyze the effect of hysteroscopic endometrial minimally invasive surgery on relative indicators of endometrial receptivity.Method Twenty patients with infertility from the gynecological clinic of a hospital from January 2017 to January 2018 were selected to observe endometrial morphology under hysteroscopy,collect endometrial specimens,and perform hysteroscopic endometrial minimally invasive surgery during implantation window stage.Hysteroscopic endometrial minimally invasive surgery was performed again 1 and 2 months after the operation,and endometrial specimens were collected at the implantation window 3 months after the operation.The changes of EP biochemical indexes before the operation and 3 months after the operation were compared.By HE staining,the secretion of endometrium was observed under an optical microscope.Immunohistochemical Streptomyces avidin peroxidase connection (SP) was used to detect the expression levels of estrogen receptor (ER),progestrone receptor (PR),leukaemia inhibitory factor (LIF),and vascular endotheli-al growth factor (VEGF) in endometrium.The levels of serum estradiol and progestrone during implantation window stage were analyzed.Embryo transfer was performed again,the implantation rate and pregnancy rate were followed up.Results The levels of serum estradiol and progestrone after surgery were slightly higher than those before the surgery,but there was no statistically significant difference.The expression levels of ER,PR and VEGF in endometrium after surgery were statistically significantly higher than those before the surgery (P＜0.05 or P＜0.01) .The implantation rate and clinical pregnancy rate of IVF-ET were 45% and 35%,respectively.Conclusion Hysteroscopic endometrial minimally invasive surgery can significantly improve endometrial receptivity,the expression levels of ER,PR and VEGF in endometrium during implantation window stage,the implantation rate and pregnancy rate of IVF-ET.