经阴道超声监测育龄女性卵泡发育评估不孕症的临床价值

The clinical value of transvaginal ultrasound in monitoring the ovarian follicular development and evaluating infertility of women in childbearing age

目的探讨经阴道超声监测育龄女性卵泡发育,及其评估不孕症和指导临床治疗不孕症的应用价值。方法对76例原发不孕症患者和85例正常育龄女性进行经阴道超声检查,共计210个周期,观察卵泡发育过程中排卵期卵泡大小及子宫内膜厚度变化,并对卵泡期、黄体期的卵巢动脉血流参数进行分析。结果 76例不孕症患者中,卵泡发育正常并且见排卵征象的48例,排卵期子宫内膜厚度(11.60±1.02)mm,占63.2%;无排卵不孕17例,处于排卵期时,子宫内膜厚度(6.63±1.05)mm,占22.0%,多囊卵巢不孕11例,处于排卵期时,子宫内膜厚度(7.54±1.30)mm,占14.8%。85例正常育龄女性排卵期,子宫内膜厚度(12.40±1.08)mm。正常组女性及不孕症中有排卵者卵巢动脉血流参数RI值在卵泡期高于黄体期,差异有统计学意义(P<0.05)。不孕症患者中无排卵患者与正常组及有排卵者比较,前者的卵巢动脉在排卵期及黄体期血流的平均血流速度均显著低于后者,差异有统计学意义(P<0.05),但RI恰好相反(P<0.05)。结论经阴道超声监测卵泡发育,观察子宫内膜厚度变化,结合卵巢动脉血流参数值的综合评估可对不孕症的诊断及治疗具有重要的临床价值。

Objective To investigate the clinical value of transvaginal ultrasound in monitoring the ovarian follicular development in women of childbearing age, and diagnosing and treating infertility. Methods 76 patients with primary infertility and 85 healthy women of childbearing age were examined by transvaginal ultrasonography in 210 cycles. The process of follicle development were observed and endometrial thickness were measured. The ovarian artery parameters including： flow velocities of ovarian stromal artery and luteal blood resistance index（RI） were measured and analyzed in both follicular phase and luteal phase. Results Of 76 cases of infertility patient, 48 case（63.2%） had normal follicular development and ovulation signs, and endometrial thickness was（11.60 ±1.02） mm during ovulation, 17 cases（22.0%）had anovulatory menstruation and endometrial thickness was（6.63 ±1.05） mm during ovulation phase. 11 cases（14.8%）had polycystic ovary and endometrial thickness was（7.54±1.30） mm during ovulation. 85 healthy women of childbearing had endometrial thickness（12.40 ±1.08） mm during ovulation. The blood flow parameter RI of ovarian artery in ovulating women（healthy plus ovulating infertility women） was higher during the follicular phase than that in the luteal phase, and there was a significant difference（P〈0.05） between the two phases. Compared to ovulating women（healthy plus ovulating infertility women）, infertility patients without ovulation had significantly lower mean ovarian stromal artery flow velocity in both ovulation and luteal phase. There was a significant difference（P〈0.05） between the two group, but the RI was the opposite（P〈0.05）. Conclusion There is important clinical value using transvaginal ultrasound to monitor ovarian follicular development, and endometrial thickness change during menstrual cycle. Combined with ovarian artery parameters, they are of importance in the diagnosis and treatment of infertility.