本文選題：子宮內(nèi)膜容受性 + 陰道超聲��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：研究背景 世界衛(wèi)生組織宣布將不孕癥與心血管病、腫瘤病列為影響當(dāng)今人類生活和健康的三大主要疾病。因此科研人員也越來越重視對不孕不育癥的研究和治療,但是不論哪種治療方法,治療的關(guān)鍵因素還是取決于優(yōu)質(zhì)的胚胎和良好的子宮內(nèi)膜容受性以及兩者間的相互應(yīng)答�，F(xiàn)代醫(yī)學(xué)對于子宮內(nèi)膜容受性的研究越來越受到重視,已經(jīng)成為世界生殖醫(yī)學(xué)系統(tǒng)研究的焦點。無論是研究還是改善內(nèi)膜容受性,都需要對內(nèi)膜容受性有良好的評價指標(biāo)。雖然現(xiàn)在判斷內(nèi)膜容受性的金標(biāo)準(zhǔn)是子宮內(nèi)膜活檢,但因其是一種有創(chuàng)性的檢查,很大程度上限制了其在臨床的應(yīng)用。超聲檢查作為一種直觀、簡便、無創(chuàng)及可重復(fù)性強(qiáng)的評價方式,有極強(qiáng)的臨床應(yīng)用價值,越來越受到推崇。相關(guān)專業(yè)人員利用超聲多普勒功能對影響子宮內(nèi)膜容受性的多個參數(shù)進(jìn)行研究。 目的 經(jīng)陰道超聲利用二維灰階、彩色多普勒、能量多普勒技術(shù),觀測促排卵治療不孕患者子宮內(nèi)膜厚度、形態(tài)特征,子宮動脈RI及PI指數(shù)、子宮內(nèi)膜下血流分布等參數(shù)來評價不孕癥患者子宮內(nèi)膜容受性。資料與方法； 2013年3月-2013年12月于我院臨床接受促排卵治療的98例不孕癥患者,采用CC/HmG/HCG促排卵方案,選擇HCG注射日進(jìn)行陰道超聲檢查,觀察子宮及卵巢的大小、形態(tài),于子宮正中矢狀切面測量子宮內(nèi)膜厚度,觀察內(nèi)膜形態(tài),測量有優(yōu)勢卵泡側(cè)子宮動脈PI及RI,利用能量多普勒觀察內(nèi)膜下血流分布。根據(jù)測量內(nèi)膜厚度分為3組：(1)7mm組；(2)7-14mm組;(3)14mm組。內(nèi)膜形態(tài)按照Gonen[1]等人的超聲下內(nèi)膜形態(tài)學(xué)分類法,對不孕患者的內(nèi)膜形態(tài)進(jìn)行分型：分為A型,典型三線型或多層子宮內(nèi)膜,即兩外層線和中央線為強(qiáng)回聲線,兩外層線與宮腔中線之間為低回聲區(qū)或暗區(qū)；B型,為均勻的中等強(qiáng)度回聲型,宮腔內(nèi)強(qiáng)回聲中央線可見但斷續(xù)；C型,內(nèi)膜為均質(zhì)的強(qiáng)回聲,宮腔中線回聲顯示不清。根據(jù)內(nèi)膜厚度分組及內(nèi)膜形態(tài)分型情況對臨床妊娠率進(jìn)行綜合分析。根據(jù)測量所得的子宮動脈PI及RI值與妊娠率進(jìn)行分析。能量多普勒下對內(nèi)膜下血流分布進(jìn)行分型,分型標(biāo)準(zhǔn)采用Applehau[2]分型法,I型：見血流信號穿過內(nèi)膜外側(cè)低回聲帶,但未達(dá)到內(nèi)膜高回聲外邊緣；Ⅱ型：見血流信號穿過內(nèi)膜高回聲外邊緣,但未進(jìn)入內(nèi)膜低回聲區(qū)；Ⅲ型：見血流信號進(jìn)入內(nèi)膜低回聲區(qū)。按妊娠與否分為兩組,進(jìn)行統(tǒng)計學(xué)分析,比較兩組間各項參數(shù)有無統(tǒng)計學(xué)差異。 結(jié)果： 98名患者經(jīng)促排卵治療后,33名患者妊娠,妊娠率為33.67%。妊娠組與非妊娠組患者一般情況比較差異無統(tǒng)計學(xué)意義。妊娠組患者內(nèi)膜厚度為10.56±2.11mm,非妊娠組患者內(nèi)膜厚度為9.34±2.57mm,兩組間差異有統(tǒng)計學(xué)意義。按內(nèi)膜厚度分組1組中15名患者無妊娠者,2組妊娠率為39.68%,3組妊娠率為40%,各組間差異有統(tǒng)計學(xué)意義；內(nèi)膜形態(tài)分組為A型組妊娠率為51.2%,B型組妊娠率為22.5%,C型組妊娠率為17.6%,各組間差異有統(tǒng)計學(xué)意義；內(nèi)膜厚度與形態(tài)綜合比較2組及3組中由A型向C型妊娠率逐漸降低,內(nèi)膜厚度一定時,A型內(nèi)膜妊娠率高；子宮動脈妊娠組PI為2.23±0.42,RI為0.71±0.15,非妊娠組PI為2.45±0.35,R1O.85±0.13,妊娠組與非妊娠組差異有統(tǒng)計學(xué)意義；能量多普勒觀察子宮內(nèi)膜下血流分型,I型組妊娠率為23.8%,II型組妊娠率為26.5%,III組妊娠率為53.6%,III型組與I型組與II型組比較差異具有統(tǒng)計學(xué)意義,I組與II組間差異沒有統(tǒng)計學(xué)意義。 結(jié)論： 在不孕癥促排卵治療中,于HCG注射日經(jīng)陰道超聲觀察內(nèi)膜形態(tài),測量子宮內(nèi)膜厚度及子宮動脈血流指數(shù),能量多普勒觀察內(nèi)膜下血流分布能夠作為評價子宮內(nèi)膜容受性的指標(biāo),對臨床不孕癥的治療有較好的指導(dǎo)意義,可以有效提高不孕癥促排卵治療的成功率。
[Abstract]:Research background
The WHO announced that infertility, cardiovascular disease, and cancer are the three major diseases that affect human life and health. Therefore, researchers are paying more and more attention to the study and treatment of infertility. However, no matter which treatment, the key factors for treatment depend on the quality of the embryo and in the good uterus. Membrane receptivity and the mutual response between the two are becoming more and more important in the study of endometrial receptivity. It has become the focus of the research in the world reproductive medicine system. Both research and improvement of endometrial receptivity require a good evaluation index for endometrial receptivity. Although gold is now judged to be tolerant of endometrium The standard is endometrial biopsy, but because it is a invasive examination, it restricts its clinical application to a large extent. Ultrasound examination is an intuitive, simple, noninvasive and repeatable evaluation method. It has a strong clinical value and is becoming more and more admired. The related professionals use the ultrasonic Doppler function to influence the children. Multiple parameters of endometrium receptivity were studied.
objective
The endometrium receptivity of infertile patients was evaluated by using two-dimensional gray scale, color Doppler and energy Doppler technique by transvaginal ultrasound. The endometrium thickness, morphological characteristics, RI and PI index of uterine artery and the distribution of the endometrium blood flow were measured to evaluate the endometrium receptivity of infertile patients.
In December -2013 March 2013, 98 cases of infertility treated with ovulation induction in our hospital, using CC/HmG/HCG to promote ovulation, selected HCG injection day for vaginal ultrasound examination, observed the size and shape of uterus and ovary, measured the endometrium thickness, observed the morphology of the endometrium, and measured the dominant follicle lateral uterus in the median sagittal section of the uterus. Artery PI and RI, using energy Doppler to observe the subintimal blood flow distribution. According to the thickness of the measured intima, there were 3 groups: (1) 7mm group; (2) 7-14mm group; (3) 14mm group. The endometrium morphology of infertile patients was classified according to Gonen[1] et al morphology classification: A type, typical three linear or multi-layer endometrium, The two outer line and the central line are strong echo lines, the two outer line and the middle line of the uterine cavity are hypoechoic or dark areas; B type is a homogeneous medium echo type, the intrauterine strong echo central line is visible but intermittent; C type, the endometrium is homogeneous strong echo, the middle line echo of the uterine cavity is not clear. According to the intimal thickness grouping and intima morphological classification feeling A comprehensive analysis of the clinical pregnancy rate was carried out. According to the measured PI and RI values of the uterine artery and the pregnancy rate, the distribution of the subintimal blood flow was classified under the energy Doppler. The classification standard was made by the Applehau[2] typing, I type: the blood flow signal passed through the inner intimal hypoechoic band, but did not reach the hyperechoic outer edge of the intima; II Type: see the blood flow signal through the hyperechoic outer edge of the endometrium, but did not enter the endometrium hypoechoic region; type III: see the blood flow signal into the endometrium hypoechoic region. According to pregnancy or not, the two groups were statistically analyzed, and there were no statistical differences between the two groups.
Result錛，

本文編號：1804321