门诊微型宫腔镜检查在不孕症患者中的临床应用

doi:10.3969/j.issn.1006-7795.2019.04.011

首都医科大学学报 ›› 2019, Vol. 40 ›› Issue (4): 549-553.doi: 10.3969/j.issn.1006-7795.2019.04.011

门诊微型宫腔镜检查在不孕症患者中的临床应用

阮祥燕^1,2, 张露平¹, 代荫梅¹, 王虎生¹, 金凤羽¹, 谷牧青¹, 程姣姣¹, 鞠蕊¹, 闵敏¹

1. 首都医科大学附属北京妇产医院内分泌科, 北京 100026;
2. 德国图宾根大学妇产医院妇女健康部与妇女健康研究中心, 图宾根 D-72076, 德国;
3. 德国科隆大学妇产医院, 科隆 D-50931, 德国

收稿日期:2019-05-20 出版日期:2019-07-21 发布日期:2019-07-19
通讯作者: 阮祥燕 E-mail:ruanxiangyan@163.com
基金资助:
北京市医院管理局"登峰"计划（DFL20181401），北京市自然科学基金（7162062），北京市医院管理局临床技术创新项目（扬帆项目）（XMLX201710）。

Clinical application of mini-hysteroscopy in infertility patients

Ruan Xiangyan^1,2, Zhang Luping¹, Dai Yinmei¹, Wang Husheng¹, Jin Fengyu¹, Gu Muqing¹, Cheng Jiaojiao¹, Ju Rui¹, Min Min¹

1. Department of Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
2. Department for Women's Health, University Women's Hospital and Research Center for Women's Health, University of Tuebingen, Tuebingen D-72076, Germany;
3. Women's Hospital Cologne-Weyerthal, University of Cologne, Cologne D-50931, Germany

Received:2019-05-20 Online:2019-07-21 Published:2019-07-19
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals'Ascent Plan(DFL20181401),Natural Science Foundation of Beijing(7162062), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(XMLX201710).

摘要/Abstract

摘要： 目的观察门诊微型宫腔镜检查在不孕症患者中的临床应用。方法分析2017年9月至2019年1月期间在首都医科大学附属北京妇产医院内分泌科接受门诊微型宫腔镜检查并有生育要求的患者159例，排除由早发性卵巢功能不全（premature ovarian insufficiency，POI）、输卵管因素导致的不孕症，排除急性或亚急性阴道生殖道炎性反应，子宫内膜病变或子宫内膜恶性肿瘤，合并严重的心血管，肝、肾系统原发疾病不宜行宫腔镜检查的患者，失访12例，最终纳入分析110例，记录患者的年龄、体质量指数（body mass index，BMI）、不孕病因、宫腔镜术前及术后促排卵周期、妊娠状态及妊娠时间，分析门诊微型宫腔镜检查对患者妊娠的影响。结果 110例患者平均年龄（31.95±4.86）岁，发现宫腔异常者77例，占70%，宫腔正常共33例，占30%。37例妊娠，占33.63%；37例妊娠患者宫腔镜检查后妊娠促排卵周期的中位数1（0~3），较宫腔镜检查前促排卵周期的中位数3（0~15）明显减少（P<0.05），其中28例为多囊卵巢综合征（polycystic ovarian syndrome，PCOS）患者宫腔镜检查后妊娠促排卵周期中位数1（0~3）较宫腔镜检查前促排卵周期的中位数3（0~15）明显减少（P<0.05），PCOS患者宫腔镜检查术后的妊娠率为40.58%（28/69）。在37例患者中，宫腔镜检查无结构性病变的患者21例，宫腔镜检查术后妊娠促排卵周期中位数为1（0~3）较宫腔镜前促排卵周期的中位数明显减少5（0~9）（P<0.05）。另外未妊娠的73例患者年龄及不孕年限较妊娠组患者明显增大，非妊娠组患者的子宫内膜炎及薄型子宫内膜的比率明显升高。结论门诊微型宫腔镜检查可以及时发现宫腔内病变，对不孕症患者宫腔因素的诊断具有很重要的应用价值，PCOS患者，微型宫腔镜检查后短期内妊娠率明显增高，其机制有待探讨。

关键词: 门诊微型宫腔镜, 不孕, 多囊卵巢综合征, 微刺激

Abstract: Objective To investigate the clinical application of mini hysteroscopy in infertility patients. Methods From Sep 2017 to Jan 2019, 159 cases of infertility patients were enrolled, who have accepted mini-hysteroscopy examination in the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. The patients who had primary ovary insufficiency, tubal infertility were excluded, patients with hysteroscopy contradiction, such as acute or sub-acute vaginal tract inflammation, endometrium lesion or endometrium carcinoma, severe cardiovascular, liver or kidney insufficiency were excluded. Twelve patients lost follow. 110 patients were eventually included in the analysis. The patient's age, body mass index (BMI), infertility etiology, preoperative and postoperative stimulate ovulation cycle, pregnancy state and pregnancy time were recorded. The effect of outpatient mini-hysteroscopy on ovulation induction cycle was analyzed in pregnant patients.Results The average age of 110 patients was 31.95±4.86 years old. 77 (70%) patients were found to have intrauterine abnormalities, while 33 (30%) patients were found to have normal intrauterine cavity. 37 cases of pregnancy, accounting for 33.63%. The median of ovulation induction cycles before and after surgery were respectively 3 (0-15)and 1 (0-3), with statistically significant differences between the two groups(P<0.05). Among the 37 pregnant patients, 21 of them had no structural lesions in hysteroscopy. The ovulation induction cycle of these patients before and after hysteroscopy were respectively 5 (0-9) and 1 (0-3), with statistically significant differences between the two groups(P0.05). Conclusion Outpatient mini-hysteroscopy can not only timely detect the intrauterine abnormalities but also provide accurate diagnosis and treatment program, suggesting a great application value for the diagnosis of uterine factors and shorten the ovulation cycle in infertility patients. In polycystic ovarian syndrome (PCOS) patients, the pregnancy rate significantly increased in the short term after mini-hysteroscopy, and the mechanism remains to be explored.

Key words: mini-hysteroscopy, infertility, polycystic ovarian syndrome(PCOS), endometrium scratch

中图分类号:

R711.11

阮祥燕, 张露平, 代荫梅, 王虎生, 金凤羽, 谷牧青, 程姣姣, 鞠蕊, 闵敏, Thomas Roemer. 门诊微型宫腔镜检查在不孕症患者中的临床应用[J]. 首都医科大学学报, 2019, 40(4): 549-553.

Ruan Xiangyan, Zhang Luping, Dai Yinmei, Wang Husheng, Jin Fengyu, Gu Muqing, Cheng Jiaojiao, Ju Rui, Min Min, Thomas Roemer. Clinical application of mini-hysteroscopy in infertility patients[J]. Journal of Capital Medical University, 2019, 40(4): 549-553.

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门诊微型宫腔镜检查在不孕症患者中的临床应用

Clinical application of mini-hysteroscopy in infertility patients

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