宫腹腔镜联合下不同术式对输卵管积水患者体外受精-胚胎移植结局的影响

Effect of different surgical procedures of laparoscopy combined with laparoscopy on the outcome of IVF-ET in patients with hydrosalpinx

目的探讨腹腔镜下双侧输卵管造口术、双侧输卵管切除术、双侧输卵管近端阻断远端造口术、双侧输卵管抽芯切除术对体外受精-胚胎移植(IVF-ET)临床结局的影响。方法回顾性分析2017年7月至2018年6月在郑州大学第三附属医院因输卵管积水就诊并行腹腔镜手术,接受IVF-ET治疗的患者122例,根据不同治疗方式分为4组,即双侧输卵管造口组(A组、29例)、双侧输卵管切除组(B组、34例)、双侧输卵管近端阻断远端造口组(C组、33例)、双侧输卵管抽芯组(D组、26例)。术后随访1年,比较各组处理后的妊娠结局,分析其影响因素。结果122例因输卵管积水导致不孕患者,经宫腹腔镜联合手术治疗后共55例(45.08%)妊娠,其中活产53例(96.36%),异位妊娠2例(1.64%),各组间IVF-ET临床妊娠率、异位妊娠率、促性腺激素(Gn)的用量、获卵数、活产率比较均无统计学差异(P>0.05)。结论宫腹腔镜联合下四种不同术式均可有效处理输卵管积水,术后IVF-ET妊娠结局相似,可以根据患者病情及意愿选用手术方式。

Objective To explore the effects of laparoscopic bilateral salpingostomy,bilateral salpingectomy,bilateral distal salpingostomy with proximal tubal occlusion and bilateral core-pulling salpingectomy on the clinical outcomes of in vitro fertilization and embryo transplantation(IVF-ET).Methods From July 2017 to June 2018,122 patients with hydrosalpinx and laparoscopic surgery in the Third Affiliated Hospital of Zhengzhou University were retrospectively analyzed.According to different treatment methods,they were divided into 4 groups:bilateral salpingostomy group(group A,29 cases),bilateral salpingectomy group(group B,34 cases),bilateral distal salpingostomy with proximal tubal occlusion group(Group C,33 cases),and bilateral core-pulling salpingectomy(group D,26 cases).All patients were followed up for 1 year after operation.The pregnancy outcomes were compared and the influencing factors were analyzed.Results Among 122 cases of infertility caused by hydrosalpinx,10 cases(8.20%)recurred.There were 55 cases of pregnancy(45.08%)after the operation with hysteroscopy and combined with laparoscopy,including 53 cases of live birth(96.36%)and 2 cases of ectopic pregnancy(1.64%).There were no statistically significant differences in the clinical pregnancy rate,ectopic pregnancy rate,dosage of gonadotropin(GN),number of oocytes and live birth rate among the groups(P>0.05).Conclusion The four surgical procedures of hysteroscopy combined with laparoscopy can all effectively treat hydrosalpinx.The pregnancy outcome of IVF-ET is similar,and the operation procedure can be selected according to the patient’s condition and wishes.