本文選題：子宮內(nèi)膜結(jié)核 + 抗結(jié)核藥�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:探討宮腔內(nèi)灌注抗結(jié)核藥物治療子宮內(nèi)膜結(jié)核的臨床療效及實施試管嬰兒助孕術(shù)后的妊娠結(jié)局。方法:選取2005年1月至2014年12月就診于我院生殖中心的不孕癥患者,經(jīng)過系統(tǒng)檢查需通過體外受精-胚胎移植術(shù)(試管嬰兒)助孕的患者中,其中41例患者進(jìn)行子宮輸卵管照影(HSG)檢查疑似生殖器結(jié)核,并通過宮腔鏡檢查同時行診斷性刮宮術(shù),刮取子宮內(nèi)膜組織送病理,病理明確診斷為子宮內(nèi)膜結(jié)核及子宮內(nèi)膜肉芽腫性炎,并且所有患者均于正規(guī)傳染病醫(yī)院篩查為非結(jié)核活動期。41例患者依據(jù)知情同意及自愿原則分成實驗組及對照組。實驗組:29例自愿接受宮腔灌注抗結(jié)核藥治療子宮內(nèi)膜結(jié)核,治愈后進(jìn)行體外授精-胚胎移植術(shù)(試管嬰兒)助孕。對照組:12例自愿接受全身抗結(jié)核藥治療子宮內(nèi)膜結(jié)核,治愈后進(jìn)行試管嬰兒助孕。兩組患者每治療一個周期后均行宮腔鏡檢查同時性診斷性刮宮術(shù)復(fù)查子宮內(nèi)膜病理,子宮內(nèi)膜結(jié)核病灶消失者為治療有效。兩組患者中得到有效治療的患者恢復(fù)3次正常月經(jīng)后行試管嬰兒助孕術(shù),并且于胚胎移植術(shù)后14天查血HCG大于正常值者為妊娠,胚胎移植術(shù)后30天行超聲檢查提示宮腔內(nèi)見到妊娠囊,胎芽及胎心搏動為臨床妊娠。對兩組患者抗結(jié)核治療的有效率、副反應(yīng)發(fā)生率、實施助孕術(shù)后的臨床結(jié)果進(jìn)行分析。結(jié)果:實驗組:26例患者治療后子宮內(nèi)膜病理提示結(jié)核病灶消失,治愈率為89.66%治療過程中有3例患者出現(xiàn)了輕微的副反應(yīng)。實施試管嬰兒助孕術(shù)后8例臨床妊娠,臨床妊娠比率為30.76%。1例胚胎移植術(shù)后17天血HCG值下降,胚胎移植術(shù)后25天恢復(fù)月經(jīng)為生化妊娠。1例胚胎移植術(shù)后30天復(fù)查彩超提示異位妊娠而行腹腔鏡手術(shù)。其余7例為宮內(nèi)妊娠狀態(tài)良好。對照組:9例患者子宮內(nèi)膜病理提示結(jié)核病灶消失,治愈率為75%。治療過程中7例患者出現(xiàn)了不同程度的副反應(yīng),其中2例患者出現(xiàn)了較重的副反應(yīng)。實施試管嬰兒助孕術(shù)后2例妊娠,妊娠率為22.22%。胚胎移植術(shù)后30天復(fù)查彩超均為宮內(nèi)妊娠狀態(tài)良好。結(jié)論:宮腔內(nèi)灌注抗結(jié)核藥物能有效治療子宮內(nèi)膜結(jié)核,副反應(yīng)發(fā)生率低且程度輕。可使子宮內(nèi)膜結(jié)核患者獲得更多的實施試管嬰兒助孕術(shù)的機(jī)會。
[Abstract]:Objective: To investigate the clinical efficacy of intrauterine antituberculous drugs in the treatment of endometrial tuberculosis and to implement the outcome of pregnancy after a test tube baby. Methods: to select the infertility patients in the reproductive center of our hospital from January 2005 to December 2014. After systematic examination, the patients who had to be assisted by in vitro fertilization embryo transfer (test tube baby) were selected. Among the 41 patients, 41 patients underwent uterine tubal illumination (HSG) to examine the suspected genital tuberculosis, and by hysteroscopy, diagnostic curettage was performed at the same time, and the endometrium tissue was removed for pathology. The pathological diagnosis was endometrial tuberculosis and endometrial granulomatous inflammation, and all patients were screened in regular infectious disease hospitals. .41 patients in the period of tuberculosis were divided into experimental group and control group according to informed consent and voluntary principle. Experimental group: 29 cases were treated voluntarily by intrauterine instillation of anti tuberculosis drugs to treat endometrium tuberculosis, and after cured in vitro fertilization and embryo transfer (test tube infant) assisted pregnancy. Control group: 12 cases voluntarily received systemic antituberculous drugs for endometrial tuberculosis, After one period of treatment, the two groups of patients were treated with hysteroscopy and diagnostic curettage after each period of treatment, and the endometrium pathology was rechecked. The patients with endometrium nodule disappearance were treated effectively. The two groups of patients received effective treatment recovered 3 times of normal month after tube baby assisted pregnancy, and in the embryo. 14 days after transplantation, the HCG was more than the normal value of pregnancy. 30 days after the embryo transfer, ultrasound examination suggested that the pregnancy sac, fetal bud and fetal heart beat were clinical pregnancy. The effective rate of anti tuberculosis treatment and the incidence of side effects in two groups were analyzed. Results: in the experimental group, 26 patients were treated. After the treatment, the pathology of endometrium showed that the tuberculosis focus disappeared, and 3 patients had minor side effects during the cure rate of 89.66%. 8 cases of clinical pregnancy after the test tube baby assisted pregnancy were carried out. The rate of clinical pregnancy was 17 days after 30.76%.1 embryo transfer, and the decrease of blood HCG value and the recovery of menstruation to.1 embryoid embryos at 25 days after the embryo transfer operation. Laparoscopy was performed on 30 days after fetal transplantation. The other 7 cases were in good state of intrauterine pregnancy. The control group: 9 cases of endometrium pathology suggested that the tuberculosis lesions disappeared, the cure rate was 7 patients in the course of 75%. treatment, with different degree of side effects, of which 2 patients had a heavier side reaction. 2 cases of pregnancy after the test tube baby assisted pregnancy, the pregnancy rate was 30 days after the 22.22%. embryo transfer, the color Doppler ultrasound was all in the state of intrauterine pregnancy. Conclusion: intrauterine infusion of anti tuberculosis drugs can effectively treat endometrial tuberculosis, the incidence of side effects is low and light. Opportunity.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.8

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