输卵管积水处理方式对体外受精-胚胎移植的影响

Effects of Management for Hydrosalpinx on the Outcome of in Vitro Fertilization and Embryo Transfer

目的:探讨腹腔镜下输卵管积水不同处理方式对体外受精-胚胎移植(IVF-ET)结局的影响。方法:对129例因输卵管因素(63例输卵管积水)行IVF-ET患者的结局进行回顾性分析。根据IVF-ET术前对输卵管积水不同处理方式将患者分为4组:积水未处理(A组)19例(19周期);腹腔镜下输卵管积水切除(B组)16例(16周期);腹腔镜下输卵管积水近端结扎远端造口(C组)28例(30周期);同期输卵管梗阻或通而不畅而无积水(D组,对照)66例(69周期)。结果:各组的促性腺激素用量、促排天数、获卵数、受精率、卵裂率、优质胚胎形成率间差异无统计学意义(P>0.05);胚胎种植率和临床妊娠率A组最低,A组7.5%(3/40),15.8%(3/19);B组31.3%(10/32),43.8%(7/16);C组33.3%(21/63),53.3%(16/30)和D组26.9%(39/145),42.0%(29/69)比较有统计学意义(P<0.05);流产率A组最高,A组66.7%(2/3),B组14.3%(1/7),C组12.5%(2/16)和D组6.9%(2/29)比较有统计学意义(P<0.05)。结论:输卵管积水降低胚胎种植率和临床妊娠率,增加流产率,在IVF-ET治疗前处理输卵管积水有助于提高胚胎种植率,改善妊娠结局。采用腹腔镜下输卵管切除术与输卵管近端结扎远端造口术对IVF-ET结局并无显著性差异。

Objective： To evaluate the effect of different treatments for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer （IVF-ET）. Methods： The data of IVF-ET outcome in 129 patients with infertility derived from tubal causes （63 patients with a history of hydrosalpinx）were analyzed retrospectively. The patients were divided into four groups according to trreatment for hydrosalpinx： no surgical procedure （Group A, 19 cases, 19 cycles）, the salpingectomy by laparoscope （Group B, 16 cases, 16 cycles）, the proximal tubal ligation and distal tubal salpingostomy by laparoscope （Group C, 28 cases, 30 cycles）, and the control group with an indication of tubal factor other than hydrosalpix in the same duration （group D, 66 cases, 69 cycles）. Results： The data revealed that there were no significant differences in the doses of gonadotrophin,the duration of stimulation, the number of retrieved ooeytes, the fertilization rates and cleavage rates（P〉0.05）. Implantation rates and clinical pregnancy rates of group A, group B, group C and group D were 7.5%（3/40） and 15.8%（3/19）, 31.3%（10/32） and 43.8%（7/16）,33.3%（21/63） and 53.3%（16/30）, and 26.9%（39/145） and 42.0%（29/69）, respectively, which showed significant difference （P〈0.05）, and those of group A were the lowest. The abortion rate of group A, group B, group C and group D were 66.7%（2/3）, 14.3%（1/7）, 12.5%（2/16） and 6.9%（2/29）, respectively, which showed significant difference（P〈0.05）, and that of group A was highest. Conclusions Hydrosalpinx may decrease the implantation rate of the embryos and increase the abortion rate. Treatments for hydrosalpinx before the IVF-ET may enhance the embryo implantation rate and improve the pregnancy outcome of IVF-ET. It appears no significant difference in the effects on the outcome of IVF- ET between the laparoscopic salpingectomy and laparoscopic proximal tubal ligation with distal tubal salpingostomy.Both of the procedures may be considered for the treatments of hydrosalpinx prior to IVF-ET.