在反复种植失败患者中应用宫腔镜检查及宫腔搔刮术的临床意义

摘要

目的 探讨宫腔镜检查及宫腔搔刮术在反复种植失败患者中应用的临床意义.方法 选择反复种植失败的不孕患者205例,根据是否行宫腔镜检查和宫腔搔刮术分为3组:A组:行宫腔镜检查联合宫腔搔刮术(n=101);B组:单纯行宫腔搔刮术(n=39);C组:未予任何干预措施(n=65).将A组按照检查情况分为宫腔形态正常组(A1组)和宫腔形态异常组(A2组),分析A组宫腔镜检查情况,并比较4组患者再次移植周期的临床妊娠率、胚胎种植率及不良妊娠率.结果 A组57.4%宫腔形态正常(A1),42.6%显示宫腔内微小病变(A2),包括子宫内膜炎、子宫内膜息肉及增生、宫腔黏连等.A1组、A2组及B组临床妊娠率与胚胎种植率均明显高于C组,差异有统计学意义(P<0.05),但A1、A2及B组间比较无统计学意义.结论 宫腔镜能显示子宫腔内微小病变,宫腔镜检查联合宫腔搔刮术和单纯搔刮术均有助于提高反复种植失败患者的临床妊娠率,但前者与后者相比并未提高临床妊娠率.%Objective To investigate the clinical significance of hysteroscopy and endometrial scratch in the patients with recurrent implantation failure.Methods 205 patients with recurrent implantation failure were enrolled.Based on the use of hysteroscopy and endometrial scratch, patients were divided into three groups: hysteroscopy combines endometrial scratch(group A, n=101), endometrial scratch alone(group B, n=39) and no specific treatment(group C,n=65).Group A was then divided into two groups according to the outcome of hysteroscopy, including normal uterine cavity(group A1) and abnormal uterine cavity(group A2).The outcome of hysteroscopy was analyzed, and rates of clinic pregnancy in next transfer cycle, implantation rates and the rates of abnormal pregnancy were compared among groups.Results In group A, 57.4% were normal uterine cavities(group A1), and 42.6% were observed with small endometrial lesions(group A2), including endometritis, endometrial polyps and intrauterine adhesions.Clinical pregnancy rates were significantly higher in group A1, A2, and B than that in group C(P<0.05).However, there were no significant difference between group A1, A2, and B.Conclusion Small endometrial lesions can be found by hysteroscopy, the treatment using hysteroscopy combines endometrial scratch or endometrial scratch alone can increase clinic pregnancy rates in the patients with recurrent implantation failure, but there is no differences between the two groups.