阴道超声评估不孕妇女子宫内膜容受性的价值研究

The value of ultrasound through vagina in evaluation of endometrium receptivity in infertile women

目的:探讨阴道超声评估子宫内膜容受性的价值。方法:对1680例处于排卵期的不孕症患者,应用阴道超声检测卵泡大小、内膜厚度,并按照内膜超声图像分为A、B、C3型,将子宫内膜厚度、类型与妊娠结局进行对照分析。结果:A型内膜占66.07%,妊娠率12.61%;B型内膜占25.00%,妊娠率9.52%;C型内膜占8.93%,妊娠率6.67%。各组成功妊娠的内膜类型以A型为主,占73.68%(140/190)。不同子宫内膜类型的妊娠率差异有统计学意义,两两比较表明,A型妊娠率高于C型(χ2=4.4546,P=0.0348),差异有统计学意义,A型与B型及B型与C型的妊娠率均无统计学差异(χ2值及P值分别为2.8005、0.0942及2.2883、1.1275)。按A型子宫内膜厚度不同分为5组,其中厚度在8～10.9mm妊娠率最高,妊娠例数占总妊娠例数的92.86%(130/140),高于厚度<8mm组和>11mm组,差异有统计学意义。按B型子宫内膜厚度不同分为5组,其中7～8.9mm组妊娠率高于其余各组,差异有统计学意义。结论:子宫内膜适合着床的理想厚度是8～10.9mm,A型内膜更适合着床。阴道B超监测子宫内膜类型与厚度在评估内膜容受性、指导临床调整用药及自然受孕或人工助孕等方面有主要价值。

objective： To investigate the value of ultrasound in evaluation of endometrium receptivity. Methods： 1680 infertile cases with ultrasound through vagina, the thickness of endometrium and the diameter of ovarian follicle were detected,then divided into three types according to ultrasound image of endometrium. The outcome of pregnancy was compared. Results： The proportion of type A cndometrium was 66. 07%, type 8 was 28.00% and type C was 8.93%. The pregnancy rate of type A group was 12.61% ,type B group was 9.52% and type C group was 6. 67%. Among the pregnancy patients, type A endometrium was 73.68% （ 140/ 190）. The pregnancy rates were significantly different among the three type groups. The pregnancy rate of type A group was significantly higher than that of type C. The pregnancy rate between type A and B or between type B and C had no significant difference （ P = 0. 0942, P = 1. 1275 ）. The cases of type A were divided into five different groups according to the thickness of endometrium. The pregnancy rate of the 8 - 10.9mm group was the highest among them. The proportion of the thickness endometrium from 8mm to 10. 9mm was 92.86% （130/140） among the pregnancy. The cases of type B also were divided into five different groups according to the thickness of endometrium. The pregnancy rate of the 7 - 8.9mm group were the highest among them. Conclusion：The most optimal thickness of endometrium is 8 - 10.9mm for nidation of embryo. Endometrium of type A has a suitable trend for nidation of embryo. It is valuable to monitor the ultrasound image of endometrium in evaluation of endometrium receptivity. It can provide guidance for clinical medication and guide the fittest conceptivity time of natural circle and artificial fertilization.