激素替代周期子宫内膜微创术在卵巢早衰患者治疗中的应用

目的探讨激素替代周期子宫内膜微创术在卵巢早衰患者治疗中的应用。方法选取2012年9月至2013年9月收治卵巢早衰患者4例(观察组),所有患者均行激素替代周期子宫内膜微创术,同时选择同期因男性因素不孕,正常月经期妇女9例(对照组)。将两组子宫内膜胞饮突在种植窗口期的情况进行观察,回顾临床资料。结果观察组在行子宫内膜微创术前,低倍镜下子宫内膜上皮呈紊乱排列,纤毛细胞部分纤毛呈缺如显示,高倍镜下隐约见微绒毛发育蔫小,微绒毛细胞和纤毛细胞皱缩,呈微量胞饮突表达。对照组患者分泌期子宫内膜有明显皱褶,表面光滑,有大量呈圆形腺体开口。胞饮突在腺体开口处较丰富,子宫内膜上皮细胞呈有序排列,胞饮突饱满圆润,纤毛细胞发育旺盛。9例正常组,处于衰退期1例、发育中阶段2例,发育完全成熟阶段6例。治疗后观察组4例术后均妊娠,3例均为单胎,孕期顺利,1例双胎,孕13周流产。结论赠卵移植反复失败的卵巢早衰患者,实施子宫内膜微创术可使子宫内膜容受性改善。子宫内膜容受性可用胞饮突来评价。

Application of minimally endometrial invasive surgery during hormone replacement cycle in patients with premature ovarian failure

Objective To evaluate minimally endometrial invasive surgery during hormone replacement cycle in patients with premature ovarian failure. Methods Four cases of premature ovarian failure who underwent minimally endometrial invasive surgery during hormone replacement cycle in our hospital from September 2012 to September 2013 were selected as study group; 9 women with normal menstrual period and male factor infertility were in control group. The endometrial pinopode during implantation window period and clinical outcomes of the patients were observed. Results In observation group,before minimally endometrial invasive surgery,endometrial epithelium had irregular arrangement,and part of the cilia of ciliated cells were absent in low magnification; and small microvilli,shrinked microvilli and ciliated cells,and trace pinopode expression were observed in high magnification. In control group,secretory endometrium had significantly wrinkled,smooth surface,a large circular gland openings and abundant pinopode in the gland openings,endometrial epithelial cells were ordered,pinopodes were full round,ciliated cells were well developed. Of 9 normal women,recession was found in one,developmental stages in two,fully developed mature stage in six. After treatment,the pregnancy outcomes in observation group were all 4 patients were pregnanted including single pregnancy in 3 and twin pregnancy in one; abortion occurred in the twin pregnancy at 13 weeks. Conclusion The implementation of minimally invasive endometrial surgery can improve endometrial receptivity in patients with recurrent failure of oocyte donation transplantation and premature ovarian failure. Pinopodes can be used for the evaluation of endometrial receptivity and clinical treatment.