助孕失败患者宫腔内病变分布特点及宫腔镜检查价值

【目的】 探讨助孕失败病人宫腔内病变病种分布特点及宫腔镜检查价值。 【方法】 采用回顾性分析,收集2011年1月到2012年7月期间在中山大学第一附属医院门诊,因助孕治疗(包括试管婴儿或人工受精)失败后进行宫腔镜检查的256例不孕患者的临床资料。 【结果】 在256例助孕失败病人中宫腔内有病变占31.25%(80/256),以子宫内膜息肉为主,占病变的55%(44/80),与继发不孕相比,息肉更常见于原发不孕(P = 0.011)。宫腔内病变其他主要病种,在原发性不孕中以子宫内膜局部增厚和子宫畸形较常见,继发不孕则以宫腔粘连和子宫内膜薄较常见。宫腔镜对息肉的正确检出率85%,高于经阴道B超(P < 0.00)。204例于宫腔镜检后再次助孕的患者总妊娠率为35.29%(72/204),宫腔镜检查结果宫腔内异常患者病变处理后再助孕的临床妊娠率高于镜检宫腔内无异常患者(45.71% vs. 29.85%, P = 0.024)。【结论】 助孕失败的不孕患者宫腔内病变以息肉为最常见,尤其原发性不孕者;其次还要关注子宫内膜厚度及宫腔形态问题、宫腔镜检查可明确宫腔内情况,及时诊断并处理常见的宫腔内膜息肉等病变,有助于改善患者再次助孕成功率。

Distribution Characteristics of Intrauterine Lesions in 256 Patients with Assisted Reproduction Failure

【Objective】 To study the distribution characteristics of intrauterine lesions in the patients with assisted reproduction failure. 【Methods】 Clinical data of 256 infertility patients, who had the failure history of assisted reproduction (including IVF and artificial insemination) and took office hysteroscopy examinations in the First Affiliated Hospital of Sun Yat-sen University from January 2011 to July 2012, were retrospectively analyzed. 【Results】 In 256 assisted reproduction failure cases, the proportion of the patients with intrauterine lesions was 31.25% (80/256) and endometrial polyps (55%) was the main abnormalities of the intrauterine lesions, which had a higher incidence rate in the primary infertility group than the secondary infertility group (P = 0.011). The less often lesions of the uterus in the primary infertility group were endometrial local thickening and uterine malformation while intrauterine adhesions and thin endometrium in the secondary infertility group. Hysteroscopy’s relevance rate of polyps was 85%, which was much higher than that of transvaginal ultrasound (P < 0.00). The total clinical pregnancy rate in these 204 patients who had accepted the assisted reproduction treatment after the office hysteroscopy examinations was 35.29% (72/204). And the clinical pregnancy rate of the next assisted reproduction after taking office hysteroscopy examinations and treatment was higher in abnormal finding than normal finding (45.71% vs 29.85%, P = 0.024). 【Conclusion】 The most common intrauterine lesion in patients with the history of assisted reproduction failure was endometrial polyps, especially for the primary infertility patients. Besides we also need to pay attention to the thickness of endometria as well as the shape of uterine cavity. The office hysteroscopy examination has a high diagnostic rate of intrauterine lesions.