宫腔粘连分离术后冻融胚胎移植周期轻刮子宫内膜对改善妊娠结局的影响研究

Observation on the effect of endometrial scratching on improving pregnancy outcome of frozen embryo transfer after transcervical resection of adhesion

目的探讨宫腔粘连分离术后子宫内膜轻刮术对冻融胚胎移植结局的影响。方法选择2011年1月至2014年12月在郑州大学附属洛阳中心医院行冻融胚胎移植(FET)的不孕症患者,在进入FET周期前宫腔镜检查确诊宫腔粘连(IUA),行宫腔镜下IUA分离术,术后复查宫腔镜显示宫腔形态正常行FET共277例。其中129例在FET前行子宫内膜轻刮术(治疗组),余148例未行子宫内膜轻刮术(对照组)。比较两组周期取消率及周期妊娠结局;将两组患者再分别分为轻度IUA组和中度IUA组,先比较治疗组和对照组内轻度和中度IUA患者的妊娠结局,再分别比较治疗组和对照组间轻度、中度IUA患者的妊娠结局。结果治疗组和对照组周期取消率差异无统计学意义[3.1%(4/129)vs.6.1%(9/148),P>0.05]。治疗组临床妊娠率[48.0%(60/125)]高于对照组[33.1%(46/139)],差异有统计学意义(P<0.05);治疗组胚胎着床率[25.2%(64/254)],高于对照组[17.8%(51/286)],差异有统计学意义(P<0.05)。与轻度IUA患者比较,两组中度IUA患者胚胎着床率及临床妊娠率均降低(P<0.05)。与治疗组中度IUA患者比较,对照组中度IUA患者临床妊娠率降低(P<0.05)。流产率和宫外孕率两组间以及两组内比较差异均无统计学意义(P>0.05)。结论子宫内膜轻刮术显著提高IUA术后患者子宫内膜容受性,尤其对中度IUA术后患者子宫内膜轻刮术可显著提高FET助孕周期妊娠率。

Objective frozen embryo transfer（FET）after transcervical resection of adhesion. Methods In a total of 277 cases with mild to moderate intrauterine adhesion（IUA）who had undergone release surgery before FET cycles,129 patients received endometrial slight scratching（treatment group）just before FET,while the other 148 didn’t receive the treatment（control group）. The pregnancy outcomes of the two groups were analyzed. Then these patients were divided into mild and moderate IOA groups.First the pregnancy outcome was compared between mild and moderate petients respectively in treatment and control group,which was then compared between the treatment and control group.Results The difference of cycle cancellation rates between the treatment group and control group was not statistically significant[3.1%（4/129）VS 6.1%（9/148）,（P〉0.05）]. The difference of clinical pregnancy rate between the treatment group and control group was significant[48.0%（60/125）vs. 33.1%（46/139）,（P〈0.05）].The embryo implantation rate in treatment group was25.2%（64/254）],higher than that of the control group[17.8%（51/286）,（P〈0.05）]. The clinical pregnancy rate of mild IUA cases were higher than thar of moderate IUA cases in the two groups respectively（P〈0.05）. The pregnancy rate of moderate IUA cases was higher in treatment group than that in control group（P〈0.05）.There was no statistical difference on abortion rate and ectopic pregnancy rate in and between the two groups（P〉0.05）.Conclusion Endometrial slight scratching may improve endometrial receptivity during FET cycles. Especially it may improve the clinical pregnancy rate of women with history of moderate IUA.