输卵管积水及其预处理后卵巢对促性腺激素的反应

The response of ovarian gonadotropin on hydrosalpinx in different laparoscopic surgical treatment

目的探讨输卵管积水经腹腔镜下不同的手术处理方式后卵巢对促性腺激素的反应。方法 选择2007年7月-2009年7月因输卵管因素在本中心行常规体外受精-胚胎移植(IVF-ET)治疗的90例不育患者,随机分为3组:A组:输卵管切除组30例;B组:输卵管近端结扎+远端造口30例;C组:输卵管远端造口30例;术前查基础内分泌促卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2),彩超测量基础窦卵泡数(Fo)、卵巢间质动脉血流的收缩期峰值(PSV),IVF前复查基础内分泌(FSH、LH、E2),彩超测量基础窦卵泡数、卵巢间质动脉血流的收缩期峰值及临床结局的影响。结果 3组术前基础内分泌比较无统计学差异(P>0.05),三组术后较术前的FSH水平显著升高(P<0.05),E2、Fo、PSV显著降低(P<0.01);A组FSH支数、刺激天数均较其他两组多,但无统计学差异(P>0.05),B组取卵数最多,临床妊娠率也最高,具有统计学差异(P<0.05)。结论输卵管积水对IVF-ET结局有负面影响,3组术后卵巢对促性腺激素的反应均有影响,以输卵管切除对卵巢功能的影响最大。

Objective To investigate the response of ovarian gonadotropin on hydrosalpinx in different laparoscopic surgical treatment.Methods 90 infertile patients who were due to tubal factors of conventional,were treated by IVF-ET in the center line,accomplished from July 2007 to July 2009.They were randomly divided into 3 groups： Group A comprised 30 cases of tubal resection;Group B comprised 30 cases proximal tubal ligation of distal stoma;Group C comprised 30 cases of tubal distal stoma;The basis of investigations endocrine（FSH,LH,E2）,the basis of color doppler ultrasound measurement of antral follicle number,ovarian blood flow index were exmined before surgical treatment.The basis of pre-endocrin（FSH,LH,E2）,the basis of color Doppler ultrasound measurement of antral follicle number,ovarian blood flow indices and clinical outcome before IVF.Results Endocrine basis of the results of three groups showed no statistical difference.After laparoscopic surgery,three groups of FSH,LH increased slightly,E2 decreased tubal resection group and Group B shows more obvious differeces,sinus reduce the number of follicles,there were statistical differences;Group A has more FSH counts and has more stimulated days,but it shows no statistically significance.Group B has the largest number of retrieved oocytes and highest clinical pregnancy rate,which shows a statistically significant difference.Conclusion Hydrosalpinx make a negative impact on the outcome of IVF-ET,three groups of patients have a right response to gonadotropin.The effects of salpingectomy on ovarian function shows the greatest.