手术及保守治疗对子宫瘢痕憩室合并宫腔积液患者行体外受精-胚胎移植妊娠结局的影响

Effect of surgical and conservative treatment on pregnancy outcome of IVF-ET in patients with uterine scar diverticulum complicated with uterine cavity effusion

目的探讨子宫瘢痕憩室合并宫腔积液患者行体外受精-胚胎移植(IVF-ET)助孕的最佳预处理方案。方法选取2019年1月至2021年6月在深圳恒生医院生殖中心行IVF-ET助孕的152例子宫瘢痕憩室合并宫腔积液患者作为研究对象,其中行经阴道子宫瘢痕憩室修补术62例(移植周期88个)作为A组,行保守治疗90例(移植周期178个)作为B组。比较两组患者的年龄、不孕年限、基础卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、孕激素(P)、抗苗勒管激素(AMH)及基础窦卵泡等基线资料和IVF-ET的助孕结局。将A组根据术后有无积液分为积液组(n=40)、无积液组(n=22),比较两组的基线资料和临床结局。结果A组的临床妊娠率为28.41%,B组为48.88%,两组比较差异具有统计学意义(P<0.05);A组与B组流产率分别为16.00%、9.19%,异位妊娠率分别为8.00%、5.75%,两组比较差异无统计学意义(P>0.05)。积液组和无积液组基线资料及移植胚胎数、移植日内膜厚度比较,差异无统计学意义(P>0.05);两组的着床率(17.82%vs.36.84%)、临床妊娠率(19.64%vs.43.75%)及流产率(27.27%vs.7.14%)比较,差异具有统计学意义(P<0.05)。结论子宫瘢痕憩室引起的宫腔积液会导致胚胎着床率下降,流产率增高。通过中医中药、臭氧液宫腔灌注等药物保守治疗与单纯经阴道瘢痕憩室修补术比较可以更好地清除宫腔积液,减少炎性渗出,提高临床妊娠率,降低流产率。

Objective To investigate the optimal pretreatment of in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy in patients with uterine scar diverticulum complicated with uterine cavity effusion.Methods 152 patients with uterine scar diverticulum complicated with uterine cavity effusion who underwent IVF-ET assisted pregnancy in Reproductive Center of Shenzhen Hengsheng Hospital from January 2019 to June 2021 were selected.Among them,62 patients(88 transplant cycles)underwent transvaginal uterine scar diverticulum repair were selected as group A,90 patients(178 transplant cycles)with conservative treatment were assigned to group B.The age,infertility years,follicle-stimulating hormone(FSH),luteinizing hormone(LH),estrogen(E_(2)),progesterone(P),anti-Müllerian hormone(AMH),basal sinus follicles and IVF-ET assisted pregnancy outcomes were compared between the two groups.Then group A was divided into effusion group(n=40)and no effusion group(n=22)according to postoperative effusion,and the baseline data and clinical outcomes of the two groups were compared.Results The clinical pregnancy rate was 28.41% in group A and 48.88% in group B,the difference between the two groups was statistically significant(P<0.05).The abortion rates of group A and group B were 16.00% and 9.19%,and the ectopic pregnancy rates were 8.00% and 5.75%,respectively.There was no significant difference between the two groups(P>0.05).There were no significant differences in baseline data,number of transplanted embryos and endometrial thickness between the effusion group and the non-effusion group(P>0.05).There were statistically significant differences in implantation rate(17.82%vs.36.84%),clinical pregnancy rate(19.64%vs.43.75%)and abortion rate(27.27%vs.7.14%)between the two groups(P<0.05).Conclusions Uterine cavity effusion accumulation caused by uterine scar diverticulum can decrease embryo implantation rate and increase abortion rate.Compared with pure transvaginal repair of scar diverticulum,conservative treatment through traditional Chinese medicine,ozone fluid intrauterine perfusion can better clear the uterine cavity effusion accumulation,reduce inflammatory exudation,improve clinical pregnancy rate,reduce abortion rate.