宫腔镜检查和子宫内膜活检在不明原因不孕症女性中的作用。

Role of hysteroscopy and endometrial biopsy in women with unexplained infertility.

作者信息

Makled Ahmed Khairy, Farghali Mohamed Mahmoud, Shenouda Demiana Samir

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt,

出版信息

Arch Gynecol Obstet. 2014 Jan;289(1):187-92. doi: 10.1007/s00404-013-2931-8. Epub 2013 Jul 20.

DOI:10.1007/s00404-013-2931-8

PMID:23872980

Abstract

OBJECTIVES

This study was designed to evaluate the role of hysteroscopy and endometrial biopsy in women with unexplained infertility.

PATIENTS AND METHODS

Women with unexplained infertility were included in this prospective study, evaluated with transvaginal sonography and diagnostic hysteroscopy. Diagnostic hysteroscopy was performed between the 7th and 11th day of the cycle. The criteria for hysteroscopic findings were based on the cervical canal, uterine cavity, endometrium, visualization of the ostium tubae and lesions of the utero-tubal junction. After the hysteroscopic examination, endometrial biopsy was performed using a Pipelle endometrial suction curette. Patients were classified according to the hysteroscopy results into four groups: patients with no abnormality detected (14), patients with cervical abnormalities (six), patients with endometrial abnormalities (73) and patients with uterine abnormalities (seven).

RESULTS

One hundred women with unexplained infertility were included. All patients underwent diagnostic hysteroscopy, except for seven patients: six patients had stenotic external or internal cervical ostium and one had inadequate visualization as the uterine cavity was filled with blood. Based on hysteroscopic findings, 31 patients were finally diagnosed with endometrial polyps; 14 endometritis; 15 endometrial hyperplasia; six submucous myomas; seven intrauterine synechiae (73 cases = endometrial abnormalities group); seven congenital uterine anomalies (uterine abnormalities group), six cervical stenosis (cervical abnormalities group) and 14 women without any uterine abnormalities (no abnormalities group). Analysis of samples obtained using the Pipelle endometrial suction curette was non-diagnostic in 16 cases; the most common endometrial pathological feature detected by this analysis was endometritis (15%).

CONCLUSIONS

Routine hysteroscopy and endometrial biopsy should be used as a basic part of the work-up for women with unexplained infertility.

摘要

目的

本研究旨在评估宫腔镜检查和子宫内膜活检在不明原因不孕症女性中的作用。

患者与方法

不明原因不孕症女性纳入本前瞻性研究，接受经阴道超声检查和诊断性宫腔镜检查。诊断性宫腔镜检查在月经周期的第7至11天进行。宫腔镜检查结果的标准基于宫颈管、子宫腔、子宫内膜、输卵管开口的可视化以及子宫输卵管交界处的病变。宫腔镜检查后，使用 Pipelle 子宫内膜吸引刮宫器进行子宫内膜活检。根据宫腔镜检查结果将患者分为四组：未检测到异常的患者（14例）、宫颈异常患者（6例）、子宫内膜异常患者（73例）和子宫异常患者（7例）。

结果

纳入100例不明原因不孕症女性。除7例患者外，所有患者均接受了诊断性宫腔镜检查：6例患者宫颈外口或内口狭窄，1例因子宫腔充满血液而可视化不充分。根据宫腔镜检查结果，最终诊断出31例子宫内膜息肉；14例子宫内膜炎；15例子宫内膜增生；6例黏膜下肌瘤；7例宫腔粘连（73例 = 子宫内膜异常组）；7例先天性子宫异常（子宫异常组），6例宫颈狭窄（宫颈异常组）和14例无任何子宫异常的女性（无异常组）。使用 Pipelle 子宫内膜吸引刮宫器获得的样本分析在16例中未得出诊断结果；该分析检测到的最常见子宫内膜病理特征是子宫内膜炎（15%）。