生殖医学杂志

目的 探讨连续3周期宫腔镜下冷刀分离术在治疗中重度宫腔粘连不孕症患者中的应用价值。方法 选取2022年4月至2023年10月于河南省生殖妇产医院确诊中重度宫腔粘连行IVF/ICSI-ET治疗的100例不孕症患者为研究对象，依据随机数字表法分成研究组(n=50)和对照组(n=50),研究组给予连续3周期宫腔镜下冷刀分离术后进行胚胎移植，对照组常规给予单周期宫腔镜下冷刀分离术后进行胚胎移植。比较两组患者的一般情况，治疗前后的子宫内膜厚度、宫腔粘连分级，月经恢复情况及妊娠结局。结果 两组患者间年龄、不孕年限、体质量指数(BMI)、基础FSH水平、窦卵泡数(AFC)、抗苗勒管激素(AMH)水平及清宫次数等一般资料比较均无显著性差异(P>0.05)。治疗后，两组患者的子宫内膜、宫腔粘连情况及月经量较治疗前均有显著改善(P<0.001),且研究组患者子宫内膜较对照组显著增厚[(9.35±1.30) mm vs.(7.50±0.86) mm,P<0.001],月经量PBAC评分显著高于对照组[(31.36±10.76) vs.(26.2±8.27),P=0.008],宫腔粘连分级较对照组显著减轻[(7.02±1.12) vs.(8.70±2.24),P<0.001],临床妊娠率(52.0%vs. 32.0%,P=0.043)和活产率(48.0%vs. 28.0%,P=0.039)均显著高于对照组。结论 对于中重度宫腔粘连不孕患者，采取连续3周期宫腔镜下冷刀分离术，可以明显改善患者的宫腔粘连分级、增加子宫内膜的厚度、改善患者的月经量，提高临床妊娠率及活产率。

Objective:To explore the application value of three consecutive cycles of hysteroscopic cold knife separation surgery in the treatment of moderate to severe intrauterine adhesion among infertility patients.Methods:A total of 100 infertile patients with moderate to severe intrauterine adhesion who underwent IVF/ICSI-ET at Henan Reproductive and Obstetric Hospital from April 2022 to October 2023 were selected as the study subjects. They were randomly divided into the study group(n=50)and the control group(n=50)using a random number table method. Patients in the study group received three consecutive cycles of hysteroscopic cold knife separation surgery followed by the embryo transfer, while those in the control group received a single cycle hysteroscopic cold knife separation surgery followed by embryo transfer. The baseline characteristics, endometrial thickness and grading of intrauterine adhesion before and after the treatment, menstrual recovery, and pregnancy outcomes of the two groups were compared.Results:There was no significant difference in the baseline characteristics in terms of age, duration of infertility, body mass index(BMI),basal FSH level, antral follicle count(AFC),anti-Müllerian hormone(AMH) level, and the number of curettage between the two groups of patients(P>0.05). The endometrium, intrauterine adhesion and menstrual volume of the two groups of patients were significantly improved after the treatment(P<0.001). After the treatment, the endometrium of the study group was significantly thicker than that of the control group [(9.35±1.30) mm vs.(7.50±0.86) mm, P<0.001],the pictorial blood-loss assessment chart(PBAC) score for menstrual flow was significantly higher in the study group than that in the control group [(31.36±10.76) vs.(26.2±8.27),P=0.008],the grade of intrauterine adhesion was significantly lower in the study group than that in the control group [(7.02±1.12) vs.(8.70±2.24),P<0.001],the clinical pregnancy rate(52.0% vs. 32.0%,P=0.043) and the live birth rate(48.0% vs. 28.0%,P=0.039) were both higher than those of the control group.Conclusions:For infertile patients with moderate to severe intrauterine adhesion, three consecutive cycles of hysteroscopic cold knife separation surgery can significantly reduce the grading of intrauterine adhesion, increase the thickness of the endometrium, improve patients' menstrual volume, and improve the clinical pregnancy rate and the live birth rate.