宫腔镜在子宫憩室患者行冻融胚胎移植中的临床研究

Clinical study of hysteroscopy in freeze thawed embryo transfer in patients with uterine diverticulum

目的探讨宫腔镜治疗对子宫憩室患者冻融胚胎移植临床结局及安全性的影响。方法选取2019年1月—2020年1月南昌市生殖医院生殖医学科收治的100例子宫憩室继发性不孕患者作为研究对象,按照随机数字表法分为对照组和研究组,每组各50例。对照组行冻融胚胎移植,研究组行宫腔镜电切手术与冻融胚胎移植。比较两组患者的临床妊娠结局及安全性指标。结果研究组的血清人绒毛膜促性腺激素阳性率、临床妊娠率、双胎率高于对照组,差异有统计学意义(P<0.05);研究组的早期流产率低于对照组,差异有统计学意义(P<0.05);两组异位妊娠及单卵双胎数比较,差异无统计学意义(P>0.05)。两组的子宫内膜处于分泌期、局灶纤维化、慢性子宫内膜炎及少量淋巴细胞浸润发生率比较,差异无统计学意义(P>0.05)。结论剖宫产后子宫憩室会降低胚胎移植患者的临床妊娠率,但在冻融胚胎移植前行宫腔镜电切手术可改善临床妊娠结局,且安全性较高。

Objective To investigate the effect of hysteroscopy on the clinical outcome and safety of frozen thawed embryo transfer in patients with uterine diverticulum.Methods A total of 100 cases of cases of patients with infertility secondary to uterine diverticulum admitted to the Department of Reproductive Medicine of Nanchang Reproductive Hospital from January 2019 to January 2020 were selected as the research objects,and divided into control group and study group according to random number table method,with 50 cases in each group.The control group received frozen thawed embryo transfer,the study group received hysteroscopic electrosurgical excision surgery and frozen thawed embryo transfer.Clinical pregnancy outcome and safety index were compared between the two groups.Results The positive rate of serum human chorionic gonadotropin,clinical pregnancy rate and twin pregnancy rate in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).The early abortion rate in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the number of ectopic pregnancy and monozygotic twins between the two groups(P>0.05).There was no significant difference in the incidence of endometrium in secretary phase,focal fibrosis,chronic endometritis and a small amount of lymphocyte infiltration between the two groups(P>0.05).Conclusion Uterine diverticulum after cesarean section can reduce the clinical pregnancy rate of embryo transfer patients,but hysteroscopic electrotomy before freeze thawed embryo transfer can improve the clinical pregnancy outcome with high safety.