宫腔镜下子宫内膜轻创术对子宫内膜容受性相关指标的影响

Effect of hysteroscopic endometrial minimally invasive surgery on relative indicators of endometrial receptivity

目的分析宫腔镜下子宫内膜轻创术对子宫内膜容受性相关指标的影响。方法选取2013年1月-2016年1月在该院接受治疗的80例体外受精-胚胎移植(IVF-ET)反复失败2次及以上且子宫内膜相对薄弱的患者,在种植窗期对上述患者进行宫腔镜子宫内膜微创术。术后利用免疫组化法检测患者手术前后子宫内膜雌激素受体(ER)、孕激素受体(PR)、白血病抑制因子(LIF)、血管内皮生长因子(VEGF)表达情况,分析患者种植窗期血清雌激素(E_2)及孕激素(P)水平,并对患者再次行胚胎移植、跟踪随访其着床率以及妊娠率。结果宫腔镜下子宫内膜轻创术治疗后患者血雌激素、孕激素水平稍高于术前,但无明显差异(P>0.05),术后子宫内膜ER、PR、LIF、VEGF表达水平较术前明显提高(P<0.01),术后患者再次进行IVF-ET着床率为38.46%,临床妊娠率为32.05%。结论:宫腔镜下子宫内膜轻创术能够显著改善子宫内膜容受性,提高种植窗期子宫内膜ER、PR、LIF、VEGF表达水平,以及IVF-ET着床率和临床妊娠率。

Objective To analyze the effect of hysteroscopie endometrial minimally invasive surgery on relative indicators of endometrial receptivity. Methods Eighty patients with thin endometrium and failing in in vitro fertilization and embryo transfer （IVF-ET） for more than two times （including two times） in the First People＇s Hospital of Nanning from January 2013 to January 2016 were selected, hyslcroscopic endometrial minimally invasive surgery was performed during implantation window stage, hnmunohistochemical method was used to detect the expression levels of estrogen receptor （ER）, progestrone receptor （PR）, leukaemia inhibitory tactor （LIF）, and vascular endothelial growth factor （VEGF） in endometrium before and after surgery. The levels of serum estradiol and progestrone during implantation window stage were analyzed. Embryo transfer was performed again, the implantation rate and pregnancy rate were followed up. Results The levels of serum estradiol and progestrone after surgery were slightly higher than those before surgery, but there was no statistically significant difference （P〉0. 05） . The expression levels of ER, PR, LIF, and VEGF in eudometrium after surgery were statistically significantly higher than those before surgery （P〈0. 01 ） . The implantation rate and clinical pregnancy rate of IVF-ET were 38.46% and 32.05% , respectively. Conclusion Hysteroscopic endometrial minimally invasive surgery can significantly improve endometrial receptivity, the expression levels of ER, PR, LIF, and VEGF in endometrium during implantation window stage, the implantation rate and pregnancy rate of IVF-ET.