门诊微型宫腔镜检查在不孕症患者中的临床应用

目的 观察门诊微型宫腔镜检查在不孕症患者中的临床应用。方法 分析2017年9月至2019年1月期间在首都医科大学附属北京妇产医院内分泌科接受门诊微型宫腔镜检查并有生育要求的患者159例，排除由早发性卵巢功能不全（premature ovarian insufficiency，POI）、输卵管因素导致的不孕症，排除急性或亚急性阴道生殖道炎性反应，子宫内膜病变或子宫内膜恶性肿瘤，合并严重的心血管，肝、肾系统原发疾病不宜行宫腔镜检查的患者，失访12例，最终纳入分析110例，记录患者的年龄、体质量指数（body mass index，BMI）、不孕病因、宫腔镜术前及术后促排卵周期、妊娠状态及妊娠时间，分析门诊微型宫腔镜检查对患者妊娠的影响。结果 110例患者平均年龄（31.95±4.86）岁，发现宫腔异常者77例，占70%，宫腔正常共33例，占30%。37例妊娠，占33.63%；37例妊娠患者宫腔镜检查后妊娠促排卵周期的中位数1（0~3），较宫腔镜检查前促排卵周期的中位数3（0~15）明显减少（P<0.05），其中28例为多囊卵巢综合征（polycystic ovarian syndrome，PCOS）患者宫腔镜检查后妊娠促排卵周期中位数1（0~3）较宫腔镜检查前促排卵周期的中位数3（0~15）明显减少（P<0.05），PCOS患者宫腔镜检查术后的妊娠率为40.58%（28/69）。在37例患者中，宫腔镜检查无结构性病变的患者21例，宫腔镜检查术后妊娠促排卵周期中位数为1（0~3）较宫腔镜前促排卵周期的中位数明显减少5（0~9）（P<0.05）。另外未妊娠的73例患者年龄及不孕年限较妊娠组患者明显增大，非妊娠组患者的子宫内膜炎及薄型子宫内膜的比率明显升高。结论 门诊微型宫腔镜检查可以及时发现宫腔内病变，对不孕症患者宫腔因素的诊断具有很重要的应用价值，PCOS患者，微型宫腔镜检查后短期内妊娠率明显增高，其机制有待探讨。

Clinical application of mini-hysteroscopy in infertility patients

Objective To investigate the clinical application of mini hysteroscopy in infertility patients. Methods From Sep 2017 to Jan 2019, 159 cases of infertility patients were enrolled, who have accepted mini-hysteroscopy examination in the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. The patients who had primary ovary insufficiency, tubal infertility were excluded, patients with hysteroscopy contradiction, such as acute or sub-acute vaginal tract inflammation, endometrium lesion or endometrium carcinoma, severe cardiovascular, liver or kidney insufficiency were excluded. Twelve patients lost follow. 110 patients were eventually included in the analysis. The patient's age, body mass index (BMI), infertility etiology, preoperative and postoperative stimulate ovulation cycle, pregnancy state and pregnancy time were recorded. The effect of outpatient mini-hysteroscopy on ovulation induction cycle was analyzed in pregnant patients.Results The average age of 110 patients was 31.95±4.86 years old. 77 (70%) patients were found to have intrauterine abnormalities, while 33 (30%) patients were found to have normal intrauterine cavity. 37 cases of pregnancy, accounting for 33.63%. The median of ovulation induction cycles before and after surgery were respectively 3 (0-15)and 1 (0-3), with statistically significant differences between the two groups(P<0.05). Among the 37 pregnant patients, 21 of them had no structural lesions in hysteroscopy. The ovulation induction cycle of these patients before and after hysteroscopy were respectively 5 (0-9) and 1 (0-3), with statistically significant differences between the two groups(P0.05). Conclusion Outpatient mini-hysteroscopy can not only timely detect the intrauterine abnormalities but also provide accurate diagnosis and treatment program, suggesting a great application value for the diagnosis of uterine factors and shorten the ovulation cycle in infertility patients. In polycystic ovarian syndrome (PCOS) patients, the pregnancy rate significantly increased in the short term after mini-hysteroscopy, and the mechanism remains to be explored.