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目的:探讨阴道B超监测不明原因反复自然流产患者排卵的临床意义。方法:采用阴道B超观察96例不明原因反复自然流产患者的卵泡生长模式(观察组),同时进行性激素测定及子宫内膜病理组织学检查。对56例92个周期给予促排卵及黄体支持治疗,观察妊娠结局。选择90例因男性因素不孕的患者作为对照组。结果:观察组卵泡发育不良综合征(FMS)发生率为79.2%(107/135),对照组FMS发生率为29.5%(37/90),二者差异有统计学意义(P<0.05);观察组中有排卵者的黄体中期雌二醇(E2)及孕激素(P)水平均明显低于对照组(P<0.05),子宫内膜分泌不良的发生率亦明显高于对照组(P<0.001);56例92个周期的促排卵及黄体支持治疗后共有48例妊娠,周期妊娠率52.1%(48/92),活产率为33.3%(42/56)。结论:卵泡发育不良是导致反复自然流产的病因之一;B超监测卵泡发育是诊断卵泡发育不良准确而有效的方法;在促排卵或黄体支持治疗中进行卵泡监测可预防再次发生自然流产。
Objective: To investigate the clinical significance of vaginal B-ultrasound for monitoring the ovulation in patients with unexplained recurrent spontaneous abortion. Methods: The follicular growth pattern (observation group) in 96 patients with unexplained recurrent spontaneous abortion was observed by vaginal ultrasound, and sex hormone test and endometrial histopathology were performed simultaneously. 56 cases of 92 cycles to promote ovulation and luteal support treatment, observe the pregnancy outcome. Ninety patients with infertility due to male factors were selected as the control group. Results: The incidence of follicular dysplasia (FMS) in observation group was 79.2% (107/135), while that in control group was 29.5% (37/90). The difference was statistically significant (P <0.05). The ovariectomized midbrain estradiol (E2) and progesterone (P) levels in the observation group were significantly lower than those in the control group (P <0.05), and the incidence of endometrial secretions was also significantly higher than that in the control group (P <0.001). There were 48 pregnancies in 56 cycles of ovulation and luteal support after 92 cycles. The pregnancy rate was 52.1% (48/92) and the live birth rate was 33.3% (42/56). Conclusions: Follicular dysplasia is one of the causes of recurrent spontaneous abortion. B-monitoring of follicular development is an accurate and effective method to diagnose follicular dysplasia. Follicle monitoring during ovulation induction or luteal support treatment can prevent spontaneous abortion.