体外受精-胚胎移植前的输卵管积水治疗

Treatment of Hydrosalpinx before IVF-ET

输卵管积水降低体外受精-胚胎移植(IVF-ET)的妊娠率、种植率,并使自然流产率增加。其可能机制是通过胚胎毒性、改变子宫内膜容受性以及通过机械性冲刷等作用影响IVF妊娠结局。目前输卵管积水治疗的方法主要包括输卵管切除术、输卵管整形术、输卵管结扎术、宫腔镜下输卵管栓塞术、经阴道超声引导下输卵管积水抽吸硬化术、中西医结合治疗等。输卵管切除术有可能影响IVF超排卵中卵巢的反应性,经阴道超声引导下输卵管积水抽吸术,虽然有简单、创伤小的优点但复发率较高。近年来,很多学者开始尝试应用新型宫腔镜下节育器Essure或者Adiana微种植体进行输卵管栓塞术治疗输卵管积水。通过总结分析输卵管积水不同治疗方案的有效性及利弊,指导临床医生为输卵管积水患者在辅助生殖前制定个性化治疗方案。

Hydrosalpinx can reduce the pregnancy rate and implantation rate of in vitro fertilization and embryo transfer （IVF-ET）, and increase the rate of spontaneous abortion. Hydrosalpinx may affect the IVF-ET clinical outcome by embryo toxicity, impairment of endometrial receptivity, mechanical hindrance to implantation. At present, the treatment options of hydrosalpinx are multifarious, including salpingectomy, salpingostomy, tubal ligation, tubal occlusion by hysteroscopy, transvaginal aspiration of fluid, and combination of Chinese and Western Medicine. Salpingectomy may affect ovarion response in IVF hyperstimulation. As for transvaginal aspiration of fluid, although there are smiple and less invasive advantages, the recurrence rate is high. The Essure and Adiana microimplant by hysteroscopy for tubal occlusion are trying to treat hydrosalpinx in clinical practice in recent years. The efficiency, advantage and disadvantage of different treatment schemes of hydrosalpinx were compared in this review, which is helpful for clinical doctors to select better individualized strategies before assisted reproductive technology（ART） treatment for those patients with hydrosalpinx.