【摘要】：研究背景：隨著宮腔鏡檢查技術(shù)在人類輔助生殖技術(shù)中的廣泛應(yīng)用,越來越多的不孕癥患者被檢出子宮內(nèi)膜息肉。子宮內(nèi)膜息肉的發(fā)病機(jī)制仍不明確,主要有以下幾個推斷：高表達(dá)的雌激素受體使子宮內(nèi)膜過過增生,形成息肉；雌激素合成限速酶芳香化酶P450局部過度表達(dá),使局部雌激素水平過高；血管內(nèi)皮生長因子(VEGF)、轉(zhuǎn)化生長因子(TGF)和胰島素樣生長因子在子宮內(nèi)膜息肉組織中的高表達(dá)；子宮內(nèi)膜局部組織細(xì)胞凋亡基因的過多表達(dá)導(dǎo)致局部內(nèi)膜細(xì)胞凋亡障礙,不能如期脫落;遺傳物質(zhì)異常。而子宮內(nèi)膜息肉導(dǎo)致不孕可能通過不規(guī)則子宮出血、長期子宮內(nèi)膜慢性炎癥反應(yīng)、改變胚胎植入所需的微環(huán)境、阻礙精卵相遇、干擾胚胎著床等。子宮輸卵管碘油造影、B超、診斷性刮宮、宮腔鏡檢查等都可以為子宮內(nèi)膜息肉的診斷提供線索,而宮腔鏡檢查及對可疑病變直視下活檢成為診斷的金標(biāo)準(zhǔn)。宮腔鏡下子宮內(nèi)膜息肉電切術(shù)是目前最好的處理辦法。對于即將行胚胎移植的不孕癥患者行息肉電切術(shù)可以顯著提高體外受精-胚胎移植即試管嬰兒的成功率。研究表明子宮內(nèi)膜局部的機(jī)械損傷誘導(dǎo)的炎癥反應(yīng)可以介導(dǎo)子宮內(nèi)膜容受性的增加,提高妊娠率,但是在宮腔鏡下息肉電切術(shù)后對子宮內(nèi)膜造成電損傷是否能達(dá)到相同效果,而什么時間適合行胚胎移植才能獲得最滿意的IVF妊娠率,目前仍沒有相關(guān)研究。 研究目的：對于接受宮腔鏡下子宮內(nèi)膜息肉電切術(shù)的患者,探討術(shù)后最佳的移植時間以獲得最高的IVF-ET成功率。 研究方法：回顧性分析2012年1月-2012年12月于我院宮腔鏡電切術(shù)后接受胚胎移植的321例患者,所有患者的息肉組織都進(jìn)行了病理檢測,將患者分成3組,第1組(G1)于術(shù)后1個月時移植(47例),第2組(G2)于術(shù)后2個月時移植(134例),第3組(G3)于術(shù)后3個月及3個月以上移植(140例),比較3組的妊娠結(jié)局。 結(jié)果：共321例接受宮腔鏡下子宮內(nèi)膜息肉電切術(shù)后行胚胎移植,其妊娠結(jié)果是：G1臨床妊娠31例,生化妊娠1例,自然流產(chǎn)5例,活產(chǎn)24例；G2臨床妊娠77例,生化妊娠4例,自然流產(chǎn)8例,活產(chǎn)68例；G3臨床妊娠29例,生化妊娠9例,自然流產(chǎn)5例,活產(chǎn)72例。其臨床妊娠率分別為66%、57.5%、56.4%,活產(chǎn)率分別為51.1%、50.7%、51.4%,生化妊娠率2.1%、3%、6.4%,自然流產(chǎn)率分別為10.6%、6%、3.6%。3組的妊娠結(jié)局之間無顯著差異性(P0.1)。結(jié)論：接受宮腔鏡下子宮內(nèi)膜息肉切除術(shù)的不孕癥患者,可根據(jù)患者的實(shí)際情況在術(shù)后1個月后任意選擇適合的胚胎移植時間。
[Abstract]:Background: with the wide application of hysteroscopy in human assisted reproduction, more and more infertility patients have been detected endometrial polyps. The pathogenesis of endometrial polyps is still unclear, mainly as follows: high expression of estrogen receptor makes endometrial hyperplasia, forming polyps; The local overexpression of estrogen synthesis rate-limiting enzyme aromatase P450 made the local estrogen level too high, the expression of vascular endothelial growth factor (VEGF), transforming growth factor (TGF) and insulin like growth factor in endometrial polyps was high. Overexpression of apoptotic genes in local endometrial tissues leads to the obstruction of apoptosis of local endometrial cells and the abscission of genetic material. Endometrial polyps may lead to infertility through irregular uterine bleeding, chronic endometrial inflammation, change the microenvironment needed for embryo implantation, hinder the meeting of sperm and eggs, interfere with embryo implantation, and so on. Hysterosalpingography, B-ultrasound, diagnostic curettage and hysteroscopy can all provide clues for the diagnosis of endometrial polyps. Hysteroscopy and biopsy of suspected lesions are the golden criteria for diagnosis of endometrial polyps. Hysteroscopic resection of endometrial polyps is the best treatment at present. Polyp electrotomy for infertile patients undergoing embryo transfer can significantly improve the success rate of in vitro fertilization and embryo transfer (IVF). Studies have shown that the inflammatory response induced by local mechanical injury of endometrium can mediate increased endometrial receptivity and increase pregnancy rate, but whether the same effect can be achieved after electroresection of polyps under hysteroscopy. No studies have been conducted on the timing of embryo transfer to achieve the most satisfactory IVF pregnancy rate. Objective: to investigate the best time of transplantation for patients undergoing hysteroscopic resection of endometrial polyps in order to obtain the highest success rate of IVF-ET. Methods: from January 2012 to December 2012, 321 patients received embryo transfer after hysteroscopic resection in our hospital were retrospectively analyzed. The polyps of all patients were examined by pathology and divided into 3 groups. Group 1 (G1) was transplanted at 1 month (47 cases), group 2 (G2) was transplanted at 2 months (134 cases), group 3 (G3) was transplanted 3 months and more than 3 months after operation (140 cases). Results: a total of 321 cases received hysteroscopic resection of endometrial polyps for embryo transfer. The results of pregnancy were as follows: 31 cases of G1 clinical pregnancy, 1 case of biochemical pregnancy, 5 cases of spontaneous abortion and 24 cases of live delivery. There were 77 cases of G2 clinical pregnancy, 4 cases of biochemical pregnancy, 8 cases of spontaneous abortion, 68 cases of live delivery, 29 cases of G3 clinical pregnancy, 9 cases of biochemical pregnancy, 5 cases of spontaneous abortion and 72 cases of live delivery. The clinical pregnancy rates were 66% 57.5% and 56.4% respectively, the live birth rates were 51.1% and 50.7%, 51.4%, the biochemical pregnancy rate 2.1% and 6.4%, and the natural abortion rate 10.6%, respectively. There was no significant difference in pregnancy outcome between the three groups (P 0.1). Conclusion: infertile patients undergoing hysteroscopic resection of endometrial polyps may choose the appropriate embryo transfer time one month after operation according to the actual situation of the patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 莫小亮;蔣曉莉;孫燕;覃桂榮;;宮腔鏡檢查在體外受精-胚胎移植中的應(yīng)用[J];廣西醫(yī)學(xué);2013年04期

2 徐蘭萍;;體外受精-胚胎移植失敗后行檢查性宮腔鏡的應(yīng)用價值[J];武漢大學(xué)學(xué)報(醫(yī)學(xué)版);2009年02期

3 周猷;龐成;何電;吉寧;侯麗艷;程怡民;;我國不孕癥研究進(jìn)展[J];中國計劃生育學(xué)雜志;2011年07期

4 林小蘭;趙鳳;;子宮切除術(shù)后患者心理健康狀況及干預(yù)效果分析[J];中國計劃生育學(xué)雜志;2012年06期

5 姜靜,張川利,王毅;子宮切除術(shù)后卵巢功能變化的觀察[J];實(shí)用婦產(chǎn)科雜志;2005年10期

6 石蕊;;不同月經(jīng)狀態(tài)下子宮內(nèi)膜息肉惡變的臨床特點(diǎn)分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2013年18期

7 牛衛(wèi)兵,徐增輝,李紅霞;腹腔鏡膽囊切除術(shù)膽管損傷的原因與預(yù)防[J];醫(yī)師進(jìn)修雜志;2003年16期

8 吳富菊;趙艷輝;關(guān)爽;;宮腔鏡聯(lián)合媽富隆治療子宮內(nèi)膜息肉的臨床觀察[J];中國婦幼保健;2009年31期

9 張師前;李楠;;補(bǔ)片在子宮切除術(shù)后陰道脫垂盆底重建術(shù)中的應(yīng)用[J];中國婦幼保健;2010年01期

10 潘萍;李素春;;子宮內(nèi)膜息肉與不孕[J];中國實(shí)用婦科與產(chǎn)科雜志;2009年11期

，

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