摘要
目的探讨腹腔镜下输卵管的不同手术方式对卵巢储备功能及体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)结局的影响。方法选择2013年8月至2014年7月新疆医科大学第一附属医院84例因输卵管因素不孕(输卵管积水或者输卵管梗阻)患者的临床资料,患者拟行IVF-ET治疗,在治疗前行腹腔镜下输卵管预处理。按手术方式的不同分为切除组(54例)和灼断组(30例),切除组患者行腹腔镜下双侧输卵管切除术,灼断组患者行腹腔镜下双侧输卵管近端灼断术。选取同期IVF-ET治疗年龄<36岁的患者40例为对照组。比较行手术预处理两组患者手术前后抗苗勒氏管激素(antimullerian hormone,AMH)值的变化;比较3组患者IVF周期中促性腺激素(gonadotropin,Gn)用量、获卵数及妊娠率。结果行手术预处理的两组患者术前术后AMH值比较,差异无统计学意义(P>0.05)。IVF结局:1 Gn用量:切除组为(2 969±805.35)U,灼断组为(2 790±1 004.43)U,对照组为(2 690.00±1 105.45)U,3组比较差异无统计学意义(P>0.05)。2获卵数:切除组(13.52±11.23)个,灼断组(14.78±10.43)个,对照组(12.35±10.71)个,3组比较差异无统计学意义(P>0.05)。3妊娠率:行手术预处理的两组患者妊娠率(切除组52.5%,灼断组50.0%)高于对照组(40.0%)(P<0.05)。结论腹腔镜下输卵管积水行切除术或者根部灼断术短期内对卵巢储备功能均无明显影响,且两种手术方式比较也无差异。但两种手术方式作预处理后,妊娠率有所提高。
Objective To evaluate effects of different laparoscopic tubal operation methods on ovarian reserve and outcomes of IVF - ET. Methods Clinical data of 84 infertility patients with tubal factors （ hydrosalpinx or oviduct obstruction） in The First Affiliated Hospital of Xinjiang Medical University from Aug 2013 to Jul 2014 were selected, all patients were conducted IVF -ET after laparoscopic tubal pretreatment. All cases were divided into excision group （ n = 54） and occlusion group （ n = 30）, patients inexcision group underwent laparoscopic bilateral salpingectomy, patients in occlusion group underwent laparoscopic proximal tubal blocking. 40 patients with IVF treatment aged less than 36y were selected as control group. The levels of preoperative and postoperative antimullerian hormone （AMH） in patients with laparoscopic tubal pretreatment between two groups were compared, the dosage of Gonadotropin （Gn）, egg number and pregnancy rate were compared between 3 groups. Results The levels of preoperative and postoperative antimullerian hormone （AMH） in patients with laparoscopic tubal pretreatment had no statistically significant difference between two groups （P 〉 0.05）. The comparison of IVF outcomes ： ① The Gn dosage ： excision group was （ 2 969 ± 805.35 ） U, occlusion group was （2 790± 1004.43）U, control group was （2 690. 0 ± 1 105.45） U, there was no statistically significant difference between 3 groups （ P 〉 0. 05 ）. ②The egg number ： excision group was （ 13.52 ± 11.23 ）, occlusion group was （ 14. 78 ± 10. 43）, control group was （12. 35 ± 10. 71 ）, there was no statistically significant difference between 3 groups （P 〉 0. 05 ）. ③ The pregnancy rate ： two groups with laparoscopic tubal pretreatment （ excision group 52. 5 %, occlusion group 50 % ） were higher than control group （40.0 % ） （P 〈 0. 05 ）. Conclusion There is no obvious effect of laparoscopic proximal tubal blocking nor laparoscopic bilateral salpingectomy on ovarian reserve in short term, 2 kinds of operation methods have no difference, but which can improve the pregnancy rate as tubal pretreatment.
出处
《中国计划生育和妇产科》
2015年第8期45-48,共4页
Chinese Journal of Family Planning & Gynecotokology
基金
新疆医科大学第一附属医院自然科学基金重点项目(项目编号:2013ZRZD17)
