B超介导下宫腔镜检查术在ART失败患者中的应用价值

目的:研究分析B超介导下非接触性宫腔镜检查术对诊断各种辅助生殖技术(ART)失败者子宫腔内异常安全性和临床应用价值。方法:2012年1月至2013年12月在我院对辅助生殖技术失败的102例患者行B超介导下宫腔镜检查术,术前均行经阴道B超检查。结果:所有的B超介导下非接触性宫腔镜检查术顺利完成,无1例并发症。102例ART失败者中B超介导下非接触性宫腔镜检查34例(33.7%)正常,68例(66.3%)异常,B超介导下宫腔镜检查术中发现宫腔异常,其中常见原因为子宫内膜息肉、子宫内膜炎、黏膜下子宫肌瘤及宫腔粘连。IVF-ET/ICSI组和AI组两组的宫腔异常阳性率无差异。经阴道B超和B超介导下宫腔镜检查术在诊断子宫疾病方面有显著性差异(P0.05)。经阴道B超主要漏诊的宫腔异常为宫腔粘连、子宫内膜炎、微小子宫内膜息肉及少见疾病如剖宫产疤痕憩室和子宫扭转。结论:B超介导下行非接触式宫腔镜检查更为安全、简单,对宫腔疾病的诊断阳性率明显高于经阴道B超检查。建议临床进一步推广。

The Clinical Value Investigation of Ultrasound Mediated Hysteroscopy for ART Failures

Objective To investigate the safety and diagnostic value of hysteroscopy in treating reproductive treatment failures （ART）. Methods 102 women who had a history of ART failures were chosen, and they were all received trans-vaginal ultrasonography before hysteroscopy. Results Diagnostic hysteroscopy was performed successfully without complications. 33 in 102 women （33.7 %） were checked normal by hysteroscopy, whereas 62 （66.3 %） hysteroscopy revealed intrauterine lesions like polyp, endometritis, sub mucosal uterine fibroids, intrauterine adhesions. There were significant differences between vaginal ultrasonography and ultrasound mediated hysteroscopy in diagnosing the intrauterine occupational disease （P 〈 0.05）0 The major missed intrauterine lesions by trans-vaginal ultrasound was intrauterine adhesions, endometritis, small endometrial polyps and rare diseases such as cesarean section scar diverticulum and rotated uterus o No statistically significant difference in the outcome was observed between women with vitro fertilization or intracytoplasmic sperm injection failures and artificial impregnation failure. Conclusion Ultrasound mediated non-contact hysteroscopy examination is more simple, safe, which were significantly higher than the transvaginal B ultrasound for the diagnosis of uterine cavity disease. The results show that this method deserve further clinical promotion.