卵巢早衰患者激素替代周期子宫内膜微创术的应用

The application of minimally endometrial invasive operation in premature ovarian failure women applied with hormone replacement therapy

目的探讨子宫内膜微创术改善卵巢早衰患者子宫内膜容受性的过程中的作用。方法研究组：选择中国人民解放军海军总医院妇产科生殖中心2007年1～10月行供卵体外受精（IVF）失败3次以上的卵巢早衰患者3例，第1周期在胚胎移植前激素替代周期第21天（种植窗口期）行子宫内膜活检，分别于第2和第3个激素替代周期的第10天行子宫内膜微创术，同期取内膜，SEM下观察子宫内膜的超微结构，选择合适的周期进行供胚移植。对照组：选择同期正常月经周期妇女10例，观察其种植窗口期子宫内膜胞饮突的发育情况。结果对照组：SEM低倍镜下分泌期子宫内膜胞饮突发育良好，且表达丰富。研究组：微创术前，SEM下子宫内膜上皮细胞排列紊乱，细胞比例失衡，没有发现胞饮突，部分细胞呈凋亡状；第1次微创术后，SEM下子宫内膜上皮细胞排列整齐，依稀可见胞饮突，凋亡情况已明显改观；第2次微创术后，SEM下子宫内膜上皮细胞排列整齐，可见较多胞饮突，无凋亡表现，与对照组无显著差异。研究组3例患者均于2次微创术后次月再次同法行微创术，当月于种植窗口期行胚胎移植术，随访得知3例均于移植后获得临床妊娠。结论子宫内膜微创术可以改善卵巢早衰患者子宫内膜容受性；胞饮突可用于评价子宫内膜容受性。

Objective To observe the development of pinopodes of the premature ovarian failure （POF）. Methods The pinopodes of 10 women with regular menstrual period were observed during implantation window as the control group. 3 POF women who had egg-donor IVF-ET failure were chosen as the experiment group, they all received Hormone Replacement Therapy （HRT） for several years ; endometrial biopsies were obtained on day 21 of the＇first HRT cycle, and endometrial uhramicrostructure was observed by SEM. During day 10 of the second and third HRT cycle, minimally endometrial invasive operation was carried out, then the biopsies was obtained as before. Results Control group： under low power lens of SEM, the pinopodes developed prosperously and ranked orderly. Test group ： before the operation, the cells of the endometrial ranked disorderly, the ciliated cells and microvillus had lost the normal proportion, and few pinopodes were seen. After the first operation, the cells ranked orderly and a few pinopodes were seen. After the second operation, the cells ranked orderly and abundant pinopodes distributed in the endometrial surface during the implantation window. After the 3^rd operation , all the 3 women were performed embryo-transform on day 21 of the last HRT cycle. The follwo-up revealed that all of the 3 women got pregnant after the 3^rd operation. Conclusion Minimally endometrial invasive operation can improve the endometrial receptivity, pinopodes play an important role in evaluating the endometrial receptivity.