宫腔镜检查对有子宫内膜微小病变的移植失败患者临床结局的影响

Effect of hysteroscopy on clinical outcome of patients with minimal endometrial lesions and failed transplantation

目的:探讨体外受精-胚胎移植(IVF-ET)失败后,再次移植前行宫腔镜手术是否可改善子宫内膜微小病变的无症状患者的临床结局。方法:回顾性分析2018年7月至2020年9月收治IVF-ET失败后行冻融胚胎移植(FET)的女性不孕症患者的临床资料。未行宫腔镜检查225例为对照组,行宫腔镜操作114例为宫腔镜组。在宫腔镜组中,宫腔镜下检查正常的49例患者为正常组,宫腔镜下行子宫内膜息肉摘除术(TCRP)的65例患者为息肉组。统计分析患者术前超声结果、一般临床资料与临床结局。结果:移植失败的142例患者经阴道超声检查的灵敏度仅为22.6%。宫腔镜组流产率低于对照组,活产率高于对照组,差异均有统计学意义(8.2%vs.20.2%,P=0.040;49.1%vs.37.8%,P=0.045)。正常组与息肉组,对照组与正常组的临床结局差异无统计学意义(P>0.05)。结论:无症状、经阴道超声检查正常却移植失败的患者可能存在子宫内膜微小病变,再次移植前行宫腔镜检查并治疗,可改善临床结局。

Objective:To investigate whether hysteroscopy can improve the clinical outcome of the asymptomatic infertility with minimal endometrial lesions after the failure of in vitro fertilization-embryo transfer(IVF-ET)but before reimplantation.Methods:The clinical data of female infertility once failed in IVF-ET treated with freeze-thaw embryo transfer(FET)from July 2018 to September 2020 were retrospective analyzed.The number of cases in the control group was 225,which did not undergo hysteroscopy,while 114 cases treated with FET after hysteroscopy were in the hysteroscopy group.In the hysteroscopy group,49 cases of all with normal uterine cavity diagnosed by hysteroscopy were in the normal group,while 65 cases treated by transcervical resection of endometrial polyp were in the polyp group.The preoperative ultrasonic results,general clinical data,clinical outcome of all cases were statistically analyzed.Results:The result of ultrasound diagnosis in 142 patients who had failed in transplantation showed that the sensitivity of ultrasound diagnosis was only 22.6%.The miscarriage rate of hysteroscopy group was lower than the control group,and the living rate in the hysteroscopy group was also higher than the control group(8.2%vs.20.2%,P=0.040;49.1%vs.37.8%,P=0.045),with significant difference.There was no significant difference in clinical outcome(P>0.05)between the normal group and the polyp group,the control group and the normal group.Conclusion:For asymptomatic infertility with normal uterine cavity diagnosed by transvaginal sonography but failed in IVF-ET,hysteroscopy is recommended in diagnosis and treatment before reimplantation.