摘要
目的探讨输卵管积水的不同腹腔镜手术处理方式对体外受精-胚胎移植(IVF-ET)临床结局的影响。方法回顾性分析2006年1月至2007年7月因输卵管因素在本中心行常规IVF-ET治疗的294例不育患者的资料,按IVF-ET前腹腔镜下输卵管积水处理方式分组:A组:双侧输卵管近端结扎术28例;B组:双侧输卵管造口术42例;C组:双侧输卵管切除术64例;D组:输卵管阻塞不伴积水80例;E组:单或双侧输卵管积水80例。比较5组患者在IVF-ET周期中卵巢对超排卵的反应性及临床结局的影响。结果C组的窦卵泡数少于B组,发育的卵泡数及获卵数少于其他4组,均有显著性差异(P<0.05);与其他4组相比,C组使用促性腺激素(Gn)的支数最多,但无显著性差异(P>0.05);E组的胚胎植入率为15.9%,临床妊娠率为27.5%,为各组间最低,其中胚胎植入率与A、C和D组比较有显著性差异,临床妊娠率与A和D组比较有显著性差异(P<0.05);各组流产率E组最高(22.7%),其次为B组(14.4%),E与C组(4%)比较有显著性差异(P<0.05);异位妊娠率E组最高,其次为B组,但各组间无显著性差异(P>0.05)。结论输卵管积水对IVF-ET结局有负面影响,对输卵管积水进行适当预处理有助于改善其临床结局。输卵管近端结扎术不降低卵巢反应性,异位妊娠率及流产率低,是IVF-ET前输卵管积水预处理较理想手术方式。
Objectives： To evaluate the effect of different laparoscopic managements for hydrosalpinx on the clinical outcome of in vitro fertilization and embryo transfer （IVF-ET）.
Methods： The data of 294 patients undergoing IVF-ET in the Reproductive Medical Center of First Affiliated Hospital of Wenzhou Medical College from January 2006 to July 2007 were analyzed retrospectively. Of 294 patients, there were 214 with hydrosalpinx and 80 with obstruction of fallopian tube but without hydrosalpinx. All the patients were divided into five groups according to the different laparoscopic managements. 28 hydrosalpinx patients in group A had been treated with proximal tubal ligation, 42 hydrosalpinx patients in group B treated with salpingostomy, 64 hydrosalpinx patients in group C treated with bilateral salpingectomy, while 80 patients with obstruction of fallopian tube （without hydrosalpinx） in group D and 80 hydrosalpinx patients in group E had their tubal problem untreated. The ovarian responses to superovulation and the clinical outcome of IVF-ET were evaluated.
Results： There was significantly lower antral follicle count in group C than in group B and fewer developed follicles and oocytes retrieved in group C than in other four groups （P〈0. 05）. The ampules of gonadotropin （Gn） administrated in group C were more than those in the other four groups, but with no significant difference （P〉0.05）. The embryo implantation rate and clinical pregnancy rate were lowest in group E. The embryo implantation rate in group E was significantly lower than that in group A, group C and group D, and the clinical pregnancy rate was significantly lower than that in group A and group D （P〈0.05）. A high miscarriage rate was found in group E and group B, and the difference between group E and group C was statistically significant （P〈0.05）. The ectopic pregnancy rate was the highest in group E, but the difference among five groups showed no statistical significance （P〉0.05）.
Conclusions： Hydrosalpinx has an adverse effect on the clinical outcome of IVF-ET and appropriate procedures may improve the outcome. Laparoscopic proximal tubal ligation has no interference with the ovarian response and low ectopic pregnancy rate and miscarriage rate, and may be considered as an ideal management prior to IVF-ET.
出处
《生殖医学杂志》
CAS
2008年第3期165-168,共4页
Journal of Reproductive Medicine
