山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (10): 80-88.doi: 10.6040/j.issn.1671-7554.0.2025.0050
• 临床医学 • 上一篇
张扬1,2,刘帅1,2,邓明铭1,2,王秋敏1,3,黄玉真1,颜磊1,2
ZHANG Yang1,2, LIU Shuai1,2, DENG Mingming1,2, WANG Qiumin1,3, HUANG Yuzhen1, YAN Lei1,2
摘要： 目的 探讨宫腔镜下息肉切除与取卵间隔时间对体外受精-胚胎移植(in vitro fertilization and embryo transfer, IVF-ET)周期结局的影响。 方法 本研究为回顾性队列研究,纳入了2014年1月至2021年12月期间在山东大学附属生殖医院被诊断为子宫内膜息肉并在IVF-ET周期前接受宫腔镜下子宫内膜息肉切除术的患者。所有患者在本中心行宫腔镜手术治疗,以及后续的辅助生殖助孕治疗。根据息肉切除至取卵的间隔时间,将患者分为5个亚组:1组(≤30 d)、2组(31~60 d)、3组(61~90 d)、4组(91~180 d)以及5组(>180 d)。比较分析各组的临床特征和妊娠结局,采用多因素Logistic回归对混杂因素进行了校正。并根据不同促排卵方案进行了分层分析。观察的主要结局指标为活产率,次要结局指标包括生化妊娠率、临床妊娠率、流产率和双胎率。 结果 根据从息肉切除到取卵的时间间隔,将2 513例患者分为5组。结局变量为术后首次新鲜胚胎移植后的妊娠结局。各组活产率差异无统计学意义( 50.8%、51.2%、54.2%、54.9%、49.7%),各项妊娠结局差异无统计学意义。Logistic回归分析和分层分析同样证实各组间差异无统计学意义。 结论 宫腔镜下息肉切除术与后续IVF-ET取卵之间的间隔时间,并不会显著影响这些周期的成功率。
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| [1] Vitale SG, Haimovich S, Laganà AS, et al. Endometrial polyps. An evidence-based diagnosis and management guide[J]. Eur J Obstet Gynecol Reprod Biol,2021,260:70-77. doi:10.1016/j.ejogrb.2021.03.017 [2] 仝佳丽, 冯力民, 薛凤霞, 等. 子宫内膜息肉临床诊疗路径[J]. 中华妇产科杂志, 2022, 57(7): 491-495. TONG Jiali, FENG Limin, XUE Fengxia, et al. Clinical pathway for diagnosis and management of endometrial polyps[J]. Chinese Journal of Obstetrics and Gynecology, 2022, 57(7): 491-495. [3] Nijkang NP, Anderson L, Markham R, et al. Endometrial polyps: pathogenesis, sequelae and treatment[J]. SAGE Open Med, 2019, 7: 2050312119848247. doi:10.1177/2050312119848247 [4] Pérez-Medina T, Bajo-Arenas J, Salazar F, et al. Endo-metrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study[J]. Hum Reprod, 2005, 20(6): 1632-1635. [5] Gu F, Zhang HX, Ruan SM, et al. High number of endometrial polyps is a strong predictor of recurrence: findings of a prospective cohort study in reproductive-age women[J]. Fertil Steril, 2018, 109(3): 493-500. [6] Zhang YN, Zhang YS, Yu Q, et al. Higher prevalence of endometrial polyps in infertile patients with endometriosis[J]. Gynecol Obstet Invest, 2018, 83(6): 558-563. [7] Fatemi HM, Kasius JC, Timmermans A, et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization[J]. Hum Reprod, 2010, 25(8): 1959-1965. [8] Carbonnel M, Pirtea P, de Ziegler D, et al. Uterine factors in recurrent pregnancy losses[J]. Fertil Steril, 2021, 115(3): 538-545. [9] Afifi K, Anand S, Nallapeta S, et al. Management of endometrial polyps in subfertile women: a systematic review[J]. Eur J Obstet Gynecol Reprod Biol, 2010, 151(2):117-121. [10] 中国优生科学协会生殖道疾病诊治分会, 中国医师协会微无创医学专业委员会妇科肿瘤学组. 子宫内膜息肉诊治中国专家共识(2022年版)[J]. 中国实用妇科与产科杂志, 2022, 38(8): 809-813. [11] Bosteels J, van Wessel S, Weyers S, et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities[J]. Cochrane Database Syst Rev, 2018, 12(12): CD009461. doi:10.1002/14651858.CD009461.pub4 [12] Hosseini MA, Ebrahimi N, Mahdavi A, et al. Hysteroscopy in patients with repeated implantation failure improves the outcome of assisted reproductive technology in fresh and frozen cycles[J]. J Obstet Gynaecol Res, 2014, 40(5): 1324-1330. [13] El-Mazny A, Abou-Salem N, El-Sherbiny W, et al. Outpatient hysteroscopy: a routine investigation before assisted reproductive techniques?[J]. Fertil Steril, 2011, 95(1): 272-276. [14] Yang JH, Chen MJ, Chen CD, et al. Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries[J]. Fertil Steril, 2013, 99(7): 2092-2096. [15] 郭艳, 杨玲玲, 夏恩兰, 等. 宫腔镜子宫内膜息肉切除术后影响息肉复发的多因素分析: 手术时机的研究[J]. 中国微创外科杂志, 2023, 23(10): 726-730. GUO Yan, YANG Lingling, XIA Enlan, et al. Multivariate analysis of factors affecting endometrial polyp recurrence after transcervical resection of polyp: a study on surgical timing[J]. Chinese Journal of Minimally Invasive Surgery, 2023, 23(10): 726-730. [16] Pereira N, Amrane S, Estes JL, et al. Does the time interval between hysteroscopic polypectomy and start of in vitro fertilization affect outcomes?[J]. Fertil Steril, 2016, 105(2): 539-544. [17] Aharon D, Sekhon L, Lee JA, et al. Optimal interval of time from operative hysteroscopy to embryo transfer in an in vitro fertilization cycle[J]. J Minim Invasive Gynecol, 2019, 26(6): 1083-1087. [18] Eryilmaz OG, Gulerman C, Sarikaya E, et al. Appro-priate interval between endometrial polyp resection and the proceeding IVF start[J]. Arch Gynecol Obstet, 2012, 285(6): 1753-1757. [19] Wang BJ, Meng N, Zhang WJ, et al. Optimal waiting period for frozen embryo transfer after hysteroscopic polypectomy: a propensity score matching analysis[J]. Front Endocrinol, 2022, 13: 986809. doi:10.3389/fendo.2022.986809 [20] Tu YA, Yang PK, Chen SU, et al. Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: a retrospective study[J]. PLoS One, 2020, 15(10): e0240882. doi:10.1371/journal.pone.0240882 [21] 祝婷, 周郁恬, 王超仪, 等. 不同促排卵方案在波塞冬低预后患者IVF/ICSI治疗中的应用进展[J]. 中华生殖与避孕杂志, 2024, 44(3): 304-309. ZHU Ting, ZHOU Yutian, WANG Chaoyi, et al. Progress in the application of different controlled ovarian stimulation protocols in IVF/ICSI treatment for POSEIDON patients[J]. Chinese Journal of Reproduction and Contraception, 2024, 44(3): 304-309. [22] Deng K, Song XH, Han XM, et al. Optimal waiting period for fresh embryo transfer after hysteroscopic adhesio-lysis: a retrospective cohort study[J]. Chin Med J, 2019, 132(19): 2333-2339. [23] Elias RT, Pereira N, Sinem Karipcin F, et al. Impact of newly diagnosed endometrial polyps during controlled ovarian hyperstimulation on in vitro fertilization outcomes[J]. J Minim Invasive Gynecol, 2015, 22(4): 590-594. [24] 李小娟, 段海霞. 辅助生殖治疗中宫腔镜手术应用及注意问题[J]. 山东大学学报(医学版), 2019, 57(10):38-44. LI Xiaojuan, DUAN Haixia. Application and key points of hysteroscopic surgery in assisted reproductive technology[J]. Journal of Shandong University(Health Science), 2019, 57(10): 38-44. [25] Guo ZZ, Xu XX, Zhang L, et al. Endometrial thickness is associated with incidence of small-for-gestational-age infants in fresh in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles[J]. Fertil Steril, 2020, 113(4): 745-752. [26] Jiang J. Endometrial polyps[J]. Am J Obstet Gynecol, 2022, 226(5): 734-735. [27] Du HL, Taylor HS. The role of hox genes in female reproductive tract development, adult function, and ferti-lity[J]. Cold Spring Harb Perspect Med, 2015, 6(1): a023002. doi:10.1101/cshperspect.a023002 [28] Riemma G, Laganà AS, Schiattarella A, et al. Ion channels in the pathogenesis of endometriosis: a cutting-edge point of view[J]. Int J Mol Sci, 2020, 21(3): 1114. doi:10.3390/ijms21031114 [29] Rackow BW, Jorgensen E, Taylor HS. Endometrial polyps affect uterine receptivity[J]. Fertil Steril, 2011, 95(8): 2690-2692. [30] Richlin SS, Ramachandran S, Shanti A, et al. Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation[J]. Hum Reprod, 2002, 17(10): 2742-2747. [31] 吴宇轩, 孟子凡, 董丽, 等. 宫腔镜子宫内膜息肉手术后冻融胚胎移植时机对妊娠结局的影响[J]. 国际生殖健康/计划生育杂志, 2024, 43(4): 274-278. WU Yuxuan, MENG Zifan, DONG Li, et al. The effect of time interval between hysteroscopic polypectomy and start of frozen-thawed embryo transfer cycles on pregnancy outcomes[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(4): 274-278. [32] 麻婷, 周怡, 杨芳, 等. 宫腔镜下息肉电切术后子宫内膜息肉复发影响因素分析[J]. 中国计划生育学杂志, 2024, 32(12): 2934-2938. MA Ting, ZHOU Yi, YANG Fang, et al. Analysis of the influencing factors of the endometrial polyp recurrence after hysteroscopic polypectomy[J]. Chinese Journal of Family Planning, 2024, 32(12): 2934-2938. [33] Xu J, Liu B, Feng X, et al. Multivariate analysis of recurrence after hysteroscopic diagnosis and treatment of endometrial polyps following IVF-ET failure[J]. Evid Based Complement Alternat Med, 2022: 4140022. doi:10.1155/2022/4140022 [34] Qu DC, Liu Y, Zhou HG, et al. Chronic endometritis increases the recurrence of endometrial polyps in pre-menopausal women after hysteroscopic polypectomy[J]. BMC Womens Health, 2023, 23(1): 88. doi:10.1186/s12905-023-02232-3 [35] Ludwin A, Lindheim SR, Booth R, et al. Removal of uterine polyps: clinical management and surgical approach[J]. Climacteric, 2020, 23(4): 388-396. |
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