输卵管栓塞术在体外受精-胚胎移植前处理输卵管积水中的应用

Application of fallopian tube embolizafion before in vitro fertilization and embryo transfer dealing with the hydrosaipinx L

目的探讨输卵管栓塞术在体外受精-胚胎移植（IVF—ET）前处理输卵管积水中的应用。方法选择因输卵管积水行输卵管栓塞术的不孕症患者46例（栓塞组）和同期双侧输卵管阻塞的不孕症患者91例（对照组），栓塞组行输卵管栓塞术，将微弹簧圈通过微导管送入输卵管间质部和峡部，1个月后行子宫输卵管造影术检查栓塞效果。栓塞术后3个月，两组患者行IVF—ET治疗，观察并比较每个周期内的平均获卵数、受精率、临床妊娠率、异位妊娠率、流产率等各项指标。结果栓塞组共栓塞82条输卵管，插管均1次成功。栓塞效果显著的输卵管有72条，占88％；有效10条，占12％；无效为0。栓塞组患者的平均获卵数（18．9个）、受精率（69%）、临床妊娠率（41％）均高于对照组（分别为17．6个、63％、39％），但差异无统计学意义（P〉0．05）；输卵管妊娠率（0）、流产率（8％）均低于对照组（分别为8％、16％），差异有统计学意义（P〈0．05）。结论输卵管栓塞术应用于IVF—ET前对输卵管积水进行处理，是一种简便、安全、经济的方法，有增加临床妊娠率的趋势，并且能杜绝输卵管妊娠的发生，是一种可行且有效的方法。

Objective To explore the effectiveness of the fallopian tubes embolization for the hydrosalpinx before in vitro fertilization and embryo transfer （IVF-ET）. Methods The fallopian tubes embolization was performed on 46 hydrosalpinx patients. First, the hysterosalpingography was performed to show the positions and shape of the hydrosalpinx. Then the hydrops was drawn into the celiac cavity in order to be absorbed after performing fallopian tube recanalization. Finally, transvaginal therapy was performed, putting the embolization microcoils into the fallopian tube through a micro-catheter. One month after the fallopian tubes embolization, hysterosalpingography was conducted to check for the effectiveness of the embolization. After 3 months, all the 46 patients received the treatment of IVF-ET. Results The interventional treatment of 82 fallopian tubes obtained one time success among 46 cases of fallopian tubes embolization. Among them, obvious results were achieved in 72 fallopian tubes, taking up 88% of the total; effective results were seen in 10 fallopian tubes, accounting for 12% of the total. No one was invalid. In the same period, compared with the 91 cases of non-hydrosalpinx as the control group, the embolization group of patients achieved a higher fertilization rate （69%）, and clinical pregnancy rate （41% ）, compared with the control group （63% and 39% respectively）, but without a significant difference （P 〉 0. 05 ）. However, the ectopic pregnancy rate（0） and the abortion rate（ 8% ） were significantly lower than the control group （8%, 16% respectively; P 〈 0. 05 ）. Conclusions Fallopian tubes embolization used in hydrosalpinx treatment before IVF-ET is an innovative approach, simple, safe, economical, with no negative impact on ovarian function. It can significantly increase the clinical pregnancy rate and prevent the occurrence of tubal pregnancy. It is a feasible and effective method.