目的 探讨不孕症患者宫腔疾病的发生率及经宫腔镜下治疗后的妊娠结局.方法 回顾性分析2015年1月-2016年8月期间因不孕症在本院就诊的8 546例经宫腔镜检查的初诊患者资料.根据患者年龄分为＜35岁组(6 786例),≥35岁组(1 760例),比较两组宫腔病变发生率.将其中移植成功的患者再根据宫腔镜诊疗结果将其分为2个亚组:正常亚组及处理亚组.其中＜35岁组中正常组共纳入2 192例,处理亚组531例;≥35岁组中正常亚组共纳入613例,处理亚组共162例.统计经宫腔镜下处理宫腔内病变并与宫腔正常者的妊娠结局进行比较.结果 ≥35岁组患者宫内病变发生率(19.66％)显著高于＜35岁组(16.92％,P=0.007),其中所占比例最高的宫腔内病变为子宫内膜息肉,发生率分别为11.36％和7.97％,其次为子宫内膜单纯增生、宫腔粘连、宫腔畸形等,最低的是子宫内膜结核;经宫腔镜对宫腔内病变的进行处理后的不孕人群中,＜35岁女性处理亚组的临床妊娠率(66.5％)与正常亚组(65.1％)差异无统计学意义(P=0.865),而≥35岁女性处理亚组临床妊娠率(24.7％)、着床率(16.5％)显著低于正常亚组(36.2％,P=0.006;23.6％,P=0.008).结论 不孕者中发生宫腔病变者约占16％～20％,通过宫腔镜处理后,＜35岁者的妊娠率能与同龄宫腔正常者持平.%Objective To explore the incidence of uterine cavity disease and the analysis of pregnancy outcome after hysteroscopic treatment.Methods Total 8 546 infertile patients who accepted hysteroscopy were analyzed retrospectively from January 2015 to August 2016.According to patients' age,they were divided into two groups:＜35-year-old group (6 786 cases),≥ 35-year-old group (1 760 cases),and the incidence of intrauterine lesions were compared between the two groups.Among the patients whose embryos were transferred sucessfully,they were divided into two subgroups according to hysteroscopy results:normal subgroup and treatment subgroup.Among the ＜35 years old group,2 192 cases were included in the normal subgroup,and 531 eases were in treatlment subgroup.Of ≥ 35-year-old group 613 cases were included in the normal subgroup and 162 cases were in treatment subgroup.The pregnancy outcomes were compared between the two subgroups.Results The incidence of intrauterine lesions in advanced women ≥ 35-year-old (19.66％) was significantly higher than women ＜35-year-old (16.92％,P=0.007).The highest proportion of intrauterine lesions was endometrial polyps in both groups,with the incidence rates of 11.36％ and 7.97％ respectively,followed by simple uterine hyperplasia,intrauterine adhesions and uterine malformations.The incidence of endometrial tuberculosis was rare.Among the infertile women who underwent hysteroscopy treatmen for intrauterine lesions,the clinical pregnancy rate (66.5％) was not significantly different from that in uterine cavity non-lesioned patients (65.1％) in women ＜35-year-old (P=0.865).However,the clinical pregnancy rate (24.7％) and implantation rate (16.5％) in the ≥ 35-year-old female treatment subgroup were significantly lower than those in the normal subgroup without uterine lesions (36.2％,P=0.006;23.6％,P=0.008).Conclusion The incidence of uterine cavity disease is 16％～20％.Hysteroscopic treatment of uterine cavity lesions can significantly improve the pregnancy outcomes of infertile patients less than 35 years of age,but for the elderly infertility patients,the pregnancy outcomes after treatment was still inferior to the normal patients of the same age.
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