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目的探讨宫腔粘连分离术后子宫内膜轻刮术对冻融胚胎移植结局的影响。方法选择2011年1月至2014年12月在郑州大学附属洛阳中心医院行冻融胚胎移植(FET)的不孕症患者,在进入FET周期前宫腔镜检查确诊宫腔粘连(IUA),行宫腔镜下IUA分离术,术后复查宫腔镜显示宫腔形态正常行FET共277例。其中129例在FET前行子宫内膜轻刮术(治疗组),余148例未行子宫内膜轻刮术(对照组)。比较两组周期取消率及周期妊娠结局;将两组患者再分别分为轻度IUA组和中度IUA组,先比较治疗组和对照组内轻度和中度IUA患者的妊娠结局,再分别比较治疗组和对照组间轻度、中度IUA患者的妊娠结局。结果治疗组和对照组周期取消率差异无统计学意义[3.1%(4/129)vs.6.1%(9/148),P>0.05]。治疗组临床妊娠率[48.0%(60/125)]高于对照组[33.1%(46/139)],差异有统计学意义(P<0.05);治疗组胚胎着床率[25.2%(64/254)],高于对照组[17.8%(51/286)],差异有统计学意义(P<0.05)。与轻度IUA患者比较,两组中度IUA患者胚胎着床率及临床妊娠率均降低(P<0.05)。与治疗组中度IUA患者比较,对照组中度IUA患者临床妊娠率降低(P<0.05)。流产率和宫外孕率两组间以及两组内比较差异均无统计学意义(P>0.05)。结论子宫内膜轻刮术显著提高IUA术后患者子宫内膜容受性,尤其对中度IUA术后患者子宫内膜轻刮术可显著提高FET助孕周期妊娠率。
Objective To investigate the effect of endometrial curettage on frozen-thawed embryo transfer after intrauterine adhesions. Methods January 2011 to December 2014 in Luoyang Central Hospital of Zhengzhou University, infertility patients with frozen-thawed embryo transfer (FET), enter the FET cycle before hysteroscopy confirmed intrauterine adhesions (IUA), Palace Endoscopic IUA separation, postoperative hysteroscopy showed uterine morphology was normal FET a total of 277 cases. Among them, 129 cases underwent endometrial scraping (FET) in FET and 148 cases without endometrial scraping (control group). The two groups were divided into mild IUA group and moderate IUA group respectively. The pregnancy outcomes of mild and moderate IUA patients in treatment group and control group were compared first, and then respectively Pregnancy outcomes were compared between mild and moderate IUA patients in the treatment and control groups. Results There was no significant difference in cycle cancellation rate between the treatment group and the control group [3.1% (4/129) vs.6.1% (9/148), P> 0.05]. The clinical pregnancy rate (48.0%, 60/125) in the treatment group was significantly higher than that in the control group (33.1%, 46/139), with significant difference (P <0.05). The embryo implantation rate in the treatment group was 25.2% (64 / 254)], higher than the control group [17.8% (51/286)], the difference was statistically significant (P <0.05). Compared with mild IUA patients, the embryo implantation rate and clinical pregnancy rate of two groups of moderate IUA patients were decreased (P <0.05). Compared with the moderate IUA patients in the treatment group, the clinical pregnancy rate of the moderate IUA patients in the control group decreased (P <0.05). Miscarriage rate and ectopic pregnancy rate between the two groups and within the two groups showed no significant difference (P> 0.05). Conclusions Endometrial skin scraping can significantly improve endometrial receptivity in patients with IUA, especially for patients with moderate IUA.