摘要
目的探讨输卵管积水不同处理方式对体外受精-胚胎移植(IVF-ET)的影响。方法回顾性分析因输卵管积水接受IVF-ET治疗的187例患者,按输卵管积水处理方案分为4组:腹腔镜患侧输卵管远端造口近端结扎组(A组,49例);B超引导下输卵管穿刺抽液组(B组,47例);腹腔镜下患侧输卵管切除组(C组,43例);输卵管积水未行处理组(D组,48例);比较各组在IVF-ET周期中卵巢对控制性超排卵的反应性以及临床结局。结果四组患者输卵管积水程度、年龄、不孕年限、基础激素(FSH、LH、E2)水平、Gn用量及使用天数、获卵数、受精率、可移植胚胎数及移植胚胎数比较,差异均无统计学意义(P>0.05)。D组的种植率和临床妊娠率最低,其中种植率显著低于其他处理组(P<0.05),B组种植率略低于A、C组,但无统计学差异(P>0.05);B、D组临床妊娠率(分别为21.3%、14.6%)显著低于A、C组(分别为46.9%、41.9%)(P<0.05),B组临床妊娠率高于D组但无统计学差异(P>0.05),A、C组妊娠率相当(P>0.05)。各组间流产率与异位妊娠率均无统计学差异(P>0.05)。结论输卵管近端结扎远端造口术损伤小、并发症少、效果良好,与输卵管切除术的临床妊娠率相当,且患者接受度更高,是IVF-ET前输卵管积水预处理较适宜的手术;B超引导穿刺抽液简单、经济、创伤更小,可提高胚胎种植率,但其妊娠结局的改善不明显,且有一定的复发率,需选择其他治疗方式。
Objective:To explore the effects of the different treatments of hydrosalpinx on the outcome of IVF-ET.Methods:A retrospective analysis was made of 187 patients who received IVF-ET treatment due to hydrosalpinx.The patients were divided into 4 groups:the patients were treated with laparoscopic proximal tubal ligation and distal tubal ostomy in group A(n=49);the patients were treated with tubal puncture and drainage under B-ultrasound guidance in group B(n=47);the patients were treated with laparoscopic salpingectomy in group C(n=43);and the patients were treated with untreated hydrosalpinx in group D(n=48).The response of ovaries to controlled ovarian hyperstimulation during IVF-ET cycles and the clinical outcomes were compared among the four groups.Results:There were no significant differences in the degree of hydrosalpinx,age,infertility years,basal level of FSH,LH,&E 2,dosage and days of Gn used,number of oocytes retrieved,fertilization rate,and number of transplantable embryos among the four groups(P>0.05).The implantation rate and clinical pregnancy rate of group D were the lowest,and the implantation rate of group D was significantly lower than that of other treatment groups(P<0.05).The implantation rate of group B was slightly lower than that of group A and C,but it was not significantly different(P>0.05).The clinical pregnancy rate of group B(21.3%)and group D(14.6%)was significantly lower than that of group A(46.9%)and group C(41.9%)(P<0.05).There was no significant difference in abortion rate and ectopic pregnancy rate among the four groups(P>0.05).Conclusions:The proximal tubal ligation and distal tubal ostomy has the advantages of less injury,less complications and good effect,and its clinical pregnancy rate is similar to that of salpingectomy.The patients have higher acceptance.Therefore,it is a more suitable operation for pre-treatment of hydrosalpinx before IVF-ET.B-ultrasound-guided aspiration is simple,economical and less traumatic,which can improve the embryo implantation rate.However,the pregnan
作者
邹闻达
刘自卫
张娟
ZOU Wen-da;LIU Zi-wei;ZHANG Juan(Reproductive Medicine Center,Zhuzhou Hospital Affiliated to XiangYa Medical College CSU,Zhuzhou412007;Department of Urology,Zhuzhou Hospital Affiliated to XiangYa Medical College CSU,Zhuzhou412007)
出处
《生殖医学杂志》
CAS
2019年第10期1184-1189,共6页
Journal of Reproductive Medicine
