三维和二维超声在胚胎移植中的应用价值比较

Comparison of advantages of three-dimensional and two-dimensional ultrasound in embryo transfer

目的探讨三维超声和二维超声在胚胎移植中的应用价值。方法试管婴儿助孕的319例患者，应用二维和三维超声观察宫腔形态，测量移植管与宫底距离（TDF），同时根据二维与三维超声所测TDF差值将所有患者分为四组（〈3mm组，3～5mm组，6～9mm组，≥10mm组），比较四组的一般情况和妊娠结局。结果三维成像后发现319例患者中41例宫腔形态异常，140例二维与三维成像具有不同程度的差异。≥10mm组临床妊娠率和胚胎着床率显著低于前三组（7．7％对34．1％、38．1％、40．0％，3．6％对18．2％、21．2%、22．2％），差异具有统计学意义（P〈0．05）。结论二维超声引导下的胚胎移植具有局限性，不能完整显示宫腔形态，放置移植管位置不够准确，会导致妊娠率和胚胎着床率显著下降。三维超声成像可明确宫腔形态，确认移植管在宫腔的理想位置，进一步提高移植成功率。

Objective To compare the advantages of three-dimensional（3D） and two-dimensional（2D） ultrasound in embryo transfer. Methods A total of 319 patients accepted embryo transfter were included in this study. 2D and 3D ultrasound were used to investigate the uterine cavity and transfer distance from the fundus （TDF）,respectivly. They were divided into four groups according to TDF difference（DTDF ） between 2D and 3D ultrasound（group of DTDF〈3 mm,group of DTDF 3-5 mm,group of 6-9 mm,group of DTDF≥10 mm. Pregnancy outcomes among the four groups were compared. Results Of the 319 patients, 41 were observed to have abnormal uterine cavity. For 140 patients, the TDF measured by 2D ultrasound were different from that measured by 3D ultrasound. Clinical pregnancy rate and implantation rate were found lowest in group of TDF ≥10 mm （7.7M vs 34.1 % ,38.1 % ,40.0% and 3.6% vs 18.2%,21.2% ,20.0%, P 〈 0.05）. Conclusions 2D ultrasound is limit and deficient for embryo transfer, especially for the visualization of uterine cavity and location of catheter tip, however, it may be better achieved with 3D ultrasound. It is helpful to use the 3D ultrasound to place the catheter tip accurately and improve the pregnancy rate of embryo transfer.