摘要
输卵管积水患者行体外受精-胚胎移植(IVF-ET)后妊娠率降低,积水对IVF的负面影响包括:1机械性冲刷;2对配子及胚胎的毒性作用;3子宫内膜容受性下降等。改善此类患者IVF结局的主要方法是阻断输卵管积水返流至宫腔;输卵管积水的处理方式应根据患者的临床症状、既往助孕结局而个体化地选择输卵管切除术、近端输卵管结扎术、输卵管造口术等。对输卵管病变较轻、功能尚可者应行输卵管造口术引流积水;对于重度积水或伴积脓、确无功能者可在IVF前切除患侧输卵管或行近端输卵管结扎术;Essure近端栓塞术对有手术禁忌证的IVF患者不失为一种选择,但有效性有待进一步观察;输卵管穿刺积水抽吸术可作为超促排卵过程新发积水的一种临时处理方式。输卵管积水最优化的治疗方案仍有待进一步评估。
Patients with hydrosalpinx are a recognized group with poor prognosis in in-vitro fertilization （IVF）. The negative effects of hydrosalpinx have generally been attributed largely to： 1） mechanical washout; 2） gamete and embryo-toxicity; 3） alterations in endometrial receptivity by the reduced expression of cytokines and integrins important to implantation. The rationale for treatments to improve the results oflVF is based on interruption of the leakage of hydrosalpinx fluid into the uterine cavity. The individual selection of the surgical method, was proximal obstruction, salpingectomy or salpingostomy, depending on patients＇ clinical findings, and previous pregnancy outcome. Laparoscopic salpingostomy suits for the patients with mild or moderate hydrosalpinx; pre-IVF laparoscopic salpingectomy or proximal tubal ligation have been shown to restore IVF-ET outcomes in patients with severe hydrosalpinx without tubal funtion. Proximal occlusion ofhydrosalpinges with Essure devices before IVF is a useful treatment for patients with a contraindication for salpingectomy. Transvaginal aspiration of the hydrosalpinx fluid is a temporary treatment in patients with newly developed hydrosalpinx in the process of controlled ovarian stimulation. The prefer treatment ofhydrosalpinx still awaits more evaluation.
出处
《生殖与避孕》
CAS
CSCD
2014年第7期584-589,共6页
Reproduction and Contraception
