【作者】 王雪；

【导师】 曹云霞；

【作者基本信息】 安徽医科大学 ， 妇产科学（专业学位）， 2018， 硕士

【摘要】 目的:探索剖宫产瘢痕憩室对体外受精-胚胎移植技术(IVF-ET)成功率的影响以及经宫颈管抽液术对剖宫产瘢痕憩室不孕症患者的治疗效果。方法:选取2016年7月1日至2017年6月30日就诊于安徽医科大学第一附属医院生殖医学中心4906例解冻移植周期中的225例剖宫产瘢痕子宫患者作为研究对象。将225例剖宫产瘢痕子宫患者分为两组:1)其中无子宫瘢痕憩室的瘢痕子宫患者有145例(SU组);2)合并剖宫产瘢痕憩室的患者有80例(PCSD组)。再根据PCSD组患者是否在子宫内膜准备期间行经宫颈管抽液术治疗将PCSD组分为2个亚组:进行过抽液术治疗的患者有32例(PCSD-治疗组);未进行治疗的患者有48例(PCSD-未治疗组)。分析各组患者的临床资料和ART成功率,并进行统计学分析。结果:PCSD组和SU组患者的年龄、体重指数、基础激素水平等一般情况均无统计学差异,但是PCSD组患者的胚胎种植率(30.30%vs.41.23%,P<0.05)和临床妊娠率(38.27%vs.53.10%,P<0.05)比SU组患者均显著降低。尽管PCSD治疗组患者的年龄、不孕年限均大于PCSD-未治疗组,但前者的临床妊娠率较后者仍有显著的提高(53.13%vs.29.17%,P<0.05)。结论:剖宫产瘢痕憩室会显著降低IVF-ET的临床妊娠率,但经宫颈管抽液术可以明显改善剖宫产瘢痕憩室不孕症患者的治疗效果。目的:通过测定整合素β3在剖宫产瘢痕憩室不孕患者子宫内膜种植窗期的表达情况,探究剖宫产瘢痕憩室对子宫内膜容受性的影响。方法:选择2016年7月至2017年4月期间就诊于安徽医科大学第一附属医院生殖医学中心因剖宫产瘢痕憩室不孕的患者15例,随机匹配因输卵管因素或男方因素需辅助生殖治疗的患者15例作为对照组。排除子宫内膜异位症、多囊卵巢综合征、卵巢功能减退、复发性流产等会明显影响ART治疗结局的病例。所有患者经阴道超声监测排卵情况,于排卵后第6-7天通过子宫内膜活检术收集内膜组织。离体子宫内膜分为2份,一部分用95%酒精固定送常规病理检查,另一部分用4%多聚甲醛固定,石蜡包埋、切片进行免疫组化实验,检测整合素β3在子宫内膜的表达情况。采用SPSS19.0统计学软件对实验数据进行统计学分析。结果:整合素β3在种植窗期子宫内膜腔上皮和腺体中呈阳性表达,位于细胞浆,呈均质状棕褐色。实验组整合素β3在子宫内膜的表达显著低于对照组(OD值0.21±0.023 vs.0.18±0.02),差异有统计学意义(P<0.001)。常规病理结果显示实验组内膜中有4例具有子宫内膜炎症,对照组均为正常分泌期内膜。结论:整合素β3在剖宫产瘢痕憩室内膜的种植窗期表达下降,提示剖宫产瘢痕憩室患者子宫内膜容受性下降。更多还原

【Abstract】 Objective:To investigate the effect of previous cesarean scar defect on the success rate of In vitro fertilization embryo transfer(IVF-ET)and the effect of cervical drainage treatment on infertile patients with previous cesarean scar defect.Methods: 225 cases of previous cesarean scar uterus were selected from 4906 frozen-thawed transfer cycles of the reproductive medicine center of Anhui Medical University from July 1,2016 to June 30,2017.There were 145 cases without PCSD(SU group)and 80 cases with previous cesarean scar defect(PCSD group).Then PCSD group were divided into two subgroups: 32 cases accepted cervical fluid drainage treatment(PCSD-treated group)and 48 cases without drainage treatment(PCSD-untreated group).The clinical data and success rate of ART were analyzed in each group.Results: There were no significant differences between PCSD group and SU group in age,BMI,basal hormone levels.However,the implantation rate(30.30% vs.41.23%,P<0.05)and clinical pregnancy rate(38.27% vs.53.10%,P<0.05)of the PCSD group were significantly lower than the SU group.Although the age and duration of infertility in the PCSD-treated group were higher than those in the PCSD-untreated group,the clinical pregnancy rate of the treatment group was significantly higher than that of the untreatment group(53.13% vs.29.17%,P<0.05).Conclusion: Previous cesarean scar defect could reduce the clinical pregnancy rate of IVF-ET,but the clinical results of patients with treatment for previous cesarean scar defect could be significantly improved by the cervical drainage treatment.Objective:To investigate the expression of integrin beta 3 during the implantation window in infertile patients with previous cesarean scar defect,to explore the impact of cesarean scar defect on endometrial receptivity.Methods: Select 15 patients with previous cesarean scar defect who had prepared to accept the ART treatment during July 2016 to April 2017 at the reproductive medicine center of the First Affiliated Hospital of Anhui Medical University.And 15 infertile patients with tubal factor or male factor were randomly matched as control group excluding endometriosis,polycystic ovary syndrome,ovarian hypofunction,recurrent abortion,and so on which could affected the ART outcome significantly.All patients were monitored ovulation by transvaginal ultrasound,and endometrial tissue was collected through endometrial biopsy on the 6-7 day after ovulation.The endometrial tissue in vitro was divided into 2 part,one part was fixed by 95% alcohol for routine pathological examination,the other part was fixed with 4% paraformaldehyde,paraffin embedded and sectioning,and immunohistochemistry was used to detect the expression of integrin beta 3 in the endometrium.The SPSS 19.0 statistical software was used to carry out statistical analysis of the experimental data.Results: The positive expression of integrin β3 was found in the endometrium epithelium and glands in the window of implantation,which was located in the cytoplasm and was homogeneous and brown.The expression of integrin β3 in the endometrium of experimental group was significantly lower than in the control group(OD 0.21 + 0.023 vs.0.18 + 0.02),the difference was statistically significant(P<0.001).The routine pathological results showed that 4 of the endometrium in the experimental group had endometritis,and the control group were all the normal secretory endometrium.Conclusion: Integrin β3 during the window of implantation of cesarean scar defect was decreased,which suggested that the patients with cesarean scar defect had lower endometrial receptivity.更多还原