本文選題：子宮內(nèi)膜異位癥 + 體外受精-胚胎移植�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：1目的探索子宮內(nèi)膜異位癥(EMS)對不孕患者經(jīng)體外受精-胚胎移植(IVF-ET)治療后妊娠結(jié)局的影響及妊娠相關(guān)因素的分析;并以小鼠為實驗對象,通過手術(shù)造模,探索子宮內(nèi)膜異位癥小鼠模型成模狀態(tài)最佳的時間,為以后相關(guān)研究提供參考,并為研究子宮內(nèi)膜異位癥對小鼠胚胎的影響做準(zhǔn)備。2方法2.1、臨床研究:選擇自2012年1月至2016年6月在我中心行IVF-ET治療的46例子宮內(nèi)膜異位癥合并不孕患者的55個取卵周期作為內(nèi)異癥組(EMS組);選擇同期行IVF-ET治療的126例非子宮內(nèi)膜異位癥患者的156個周期作為對照組(非EMS組),平衡兩組患者的一般情況后,從CA-125水平、竇卵泡數(shù)(AFC)、促排卵藥物啟動量/總量、HCG日內(nèi)膜厚度/類型、HCG日大卵泡數(shù)(直徑≥14mm卵泡)、HCG日雌二醇(estrogen,E2)、HCG日每大卵泡數(shù)E2、獲卵數(shù)、受精方式、MII數(shù)、正常受精數(shù)/卵裂數(shù)、優(yōu)胚數(shù)、正常受精率、卵裂率、優(yōu)胚率、胚胎著床率、生化妊娠率、臨床妊娠率、早期流產(chǎn)率、活產(chǎn)率、周期取消率等方面進行回顧性分析,了解EMS對EMS相關(guān)性不孕患者的實驗室及臨床結(jié)局的影響;再將兩組臨床資料按臨床結(jié)局分別分為妊娠組、未妊娠組,進一步明確EMS組和非EMS組中與妊娠結(jié)局相關(guān)的因素。2.2、實驗研究:1)選擇6周齡雌性無特殊病原體(specific pathogen free,SPF)級KM(昆明)小鼠33只,隨機分為三組,每組11只。2)適應(yīng)新環(huán)境1周后,手術(shù)取出小鼠左側(cè)子宮角,均分為4段,剪開子宮腔,得到四塊子宮組織。其中兩塊組織以內(nèi)膜面朝向腹壁的方向分別縫合在切口兩側(cè)腹壁上,一塊組織剪碎后注入小鼠腹腔,剩余一塊組織送病理檢查,以確認(rèn)所取組織來源于小鼠子宮;三組小鼠均采用此方法建立子宮內(nèi)膜異位癥模型。3)于手術(shù)后2周、3周、4周分別處死三組小鼠,觀察內(nèi)異灶形態(tài),并進行如下統(tǒng)計計算:(1)比較各組小鼠的術(shù)后存活率、不同部位病灶形成率、異位灶囊泡形成率及模型成功率;(2)組內(nèi)比較腹壁、網(wǎng)膜、腸壁三個部位組織碎片的種植成功率;(3)組內(nèi)比較縫合、碎片種植、縫合+碎片種植三種建模方式的成功率;(4)比較三組小鼠異位病灶的平均體積。3結(jié)果3.1、臨床研究:EMS組CA-125水平、周期取消率高于對照組(P0.05);基礎(chǔ)竇卵泡數(shù)(AFC)、HCG日大卵泡數(shù)、獲卵數(shù)、MII數(shù)、2PN數(shù)、卵裂數(shù)、優(yōu)胚數(shù)、優(yōu)胚率低于對照組(P0.05);HCG日大卵泡數(shù)與EMS患者妊娠失敗的相關(guān)回歸系數(shù)小于0(P0.05)。3.2、實驗研究:本實驗采用KM小鼠進行EMS的建模,參與本實驗的33只小鼠中,術(shù)后存活28只。(1)三組小鼠術(shù)前未區(qū)分動情周期,但術(shù)后存活率、各部位病灶形成率、囊泡形成率及模型成功率比較,差異均無統(tǒng)計學(xué)意義(P0.05);(2)三組的組內(nèi)腹壁、網(wǎng)膜、腸壁三個部位內(nèi)膜碎片種植成功率的比較,差異均無統(tǒng)計學(xué)意義(P0.05);(3)三組中組內(nèi)縫合、碎片種植、縫合+碎片種植三種方式建模方式成功率的比較,其中僅術(shù)后4周組中碎片種植比縫合、縫合+碎片種植兩種建模方式的成功率低,差異有統(tǒng)計學(xué)意義(P0.05),后兩者方式的建模成功率均為100%;(4)三組小鼠異位病灶平均體積比較結(jié)果顯示,術(shù)后2周小鼠異位病灶體積小于術(shù)后4周小鼠異位病灶體積(4.00±2.85mm3 Vs.25.64±15.93mm3,P=0.001),差異有顯著性統(tǒng)計學(xué)意義。4結(jié)論4.1、臨床研究:子宮內(nèi)膜異位癥合并不孕患者卵巢儲備功能下降,胚胎質(zhì)量下降,更容易取消周期。但其卵子成熟率、正常受精率、卵裂率及臨床結(jié)局與非內(nèi)異癥不孕患者相比無明顯差別;HCG日大卵泡數(shù)是EMS患者妊娠的保護因素。4.2、實驗研究:1)術(shù)后2周EMS模型已成功,且造模前無需統(tǒng)一動情周期;2)子宮組織碎片在腹壁、大網(wǎng)膜、腸壁的種植率無差異;3)術(shù)后2-3周行下一步研究的,可采用子宮組織碎片腹腔種植法建模;術(shù)后4周行下一步研究的,可采用子宮片段腹壁縫合法建模;4)造模術(shù)后4周,異位灶平均體積最大,EMS模型效果最佳。
[Abstract]:1 Objective To explore the effect of endometriosis (EMS) on pregnancy outcome after the treatment of in vitro fertilization and embryo transfer (IVF-ET) and the analysis of pregnancy related factors. In order to study the effect of endometriosis on mouse embryos,.2 method 2.1 was prepared. Clinical study: 55 oval cycles in 46 cases of endometriosis with infertility from January 2012 to June 2016 were selected as endometriosis group (group EMS), and 126 non endometrium were selected for IVF-ET treatment at the same time. 156 cycles of heterotopic patients (non EMS group), balance two groups of patients, from the level of CA-125, the number of sinus follicles (AFC), the amount of oviposit promoter / total, HCG diurnal intima thickness / type, HCG day large follicle number (diameter > 14mm follicle), HCG day estradiol (estrogen, E2), HCG day per large follicle number E2, the number of eggs, fertilized square Formula, MII number, normal fertilization number / cleavage number, optimal embryo number, normal fertilization rate, cleavage rate, excellent embryo rate, embryo implantation rate, biochemical pregnancy rate, clinical pregnancy rate, early abortion rate, survival rate, cycle cancellation rate, etc., to understand the effect of EMS on the laboratory and clinical outcome of EMS related infertile patients; and then two groups of clinical funds According to the clinical outcome, the material was divided into pregnancy group and non pregnancy group, and the factors related to pregnancy outcome in group EMS and non EMS group were further clarified.2.2, experimental study: 1) 33 mice of 6 weeks old female without special pathogen (specific pathogen free, SPF) KM (Kunming) mice were selected, and were divided into three groups, each group of 11.2) adapted to the new environment for 1 weeks and the operation was removed. The left corner of the uterus of the mice was divided into 4 segments, and the uterine cavity was cut open and four uterine tissues were cut. Among them, two tissues were sutured on both sides of the abdominal wall in the direction of the endometrium toward the abdominal wall. One tissue was cut into the abdominal cavity, and the rest of the tissue was sent to the pathological examination to confirm that the tissues were derived from the uterus of mice; the three groups were all of the mice. Using this method to establish endometriosis model.3), three groups of mice were killed at 2 weeks, 3 weeks and 4 weeks after the operation. The morphology of the endometrium was observed and the following statistical calculations were performed. (1) the survival rate, the rate of focal lesion formation in different parts of the mice, the formation rate of the ectopic foci and the success rate of the model were compared. (2) the abdominal wall, omentum, and the wall of the intestine were compared in the group (2) The success rate of tissue fragmentation in three parts; (3) the success rate of three modeling methods: comparison suture, shard planting, suture + fragment planting; (4) the average volume of.3 in three groups of mice was 3.1. Clinical study: the CA-125 level in group EMS was higher than that of the control group (P0.05); the number of basal sinus follicles (AFC), and large follicle of HCG day Number, number of eggs, MII number, 2PN number, cleavage number, optimal embryo number, optimal embryo rate lower than that of control group (P0.05); the correlation coefficient of large follicle number and EMS patient's pregnancy failure was less than 0 (P0.05).3.2, experimental study: this experiment used KM mice to model EMS, and 28 mice survived the 33 mice in this experiment. (1) three groups of mice did not distinguish before operation. The estrous cycle, but the postoperative survival rate, the rate of lesion formation, the rate of vesicle formation and the success rate of the model were not statistically significant (P0.05). (2) there was no significant difference in the success rate of the internal abdominal wall, omentum and the three parts of the intestinal wall of the three groups (P0.05); (3) the three groups of sutures, shards, suture + The success rates of three modeling methods were compared, in which only 4 weeks after operation, the success rate of two kinds of modeling methods, including shard planting ratio suture, suture + fragment planting, was statistically significant (P0.05), and the success rate of the latter two models was 100%. (4) the average volume comparison of the three groups of heterotopic lesions showed that 2 weeks after the operation. The volume of heterotopic focus in mice was less than 4 weeks after the operation (4 + 2.85mm3 Vs.25.64 + 15.93mm3, P=0.001). The difference was statistically significant.4 conclusion 4.1. Clinical study: the ovarian reserve function of endometriosis combined with infertility decreased, the quality of embryo decreased and the cycle was easier to cancel, but the rate of egg maturation was normal. There was no significant difference in fertilization rate, cleavage rate and clinical outcome compared with infertile infertility; HCG day large follicle number was a protective factor for pregnancy in EMS patients.4.2, experimental study: 1) 2 weeks after the operation, EMS model had been successful, and no unified estrous cycle was needed before modeling; 2) the implantation rate of uterine tissue fragments on abdominal wall, omentum, and intestinal wall was no difference; 3) 2-3 after operation. The next step of study in the next week can be modeled by the method of intraperitoneal implantation of uterine tissue fragments. 4 weeks after the operation, the next step of the study can be modeled by the uterine segment abdominal suture; 4) the average volume of the heterotopic focus is the largest after 4 weeks, and the EMS model is the best.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.71;R-332

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