体外受精—胚胎移植患者输卵管积水不同处理方式对妊娠结局的影响

Different therapeutic effects of hydrosalpinx on pregnancy outcome in patients undergoing in vitro fertilization and embryo transfer

目的探究体外受精—胚胎移植(IVF-ET)患者输卵管积水不同处理方式对妊娠结局的影响。方法选取2013年6月—2015年10月梅州市人民医院妇二科因输卵管因素不孕行IVF-ET治疗的患者126例,根据IVFET治疗前患者输卵管积水的严重程度不同分为3组,A组患者(输卵管轻度积水)42例,采用输卵管伞端造口术;B组患者(输卵管中度积水)42例,采用输卵管近端结扎远端造口术;C组患者(输卵管重度积水)42例,采用输卵管切除术。对比3组患者术前和术后第3次月经性激素六项指标、窦卵泡数目、促性腺激素(Gn)用量、用药时间、hGG注射日E_2水平、获卵数、可移植胚胎数、临床妊娠妊娠率、流产率、异位妊娠率。结果 3组患者术前、术后第3次月经周期六项激素指标水平及窦卵泡数目间差异均无统计学意义(P>0.05);3组间对比六项激素指标水平及窦卵泡数目差异均无统计学意义(P>0.05)。3组患者在Gn用药量、用药时间、hGG注射日E_2水平、可移植胚胎数差异均无统计学意义(P>0.05);A组、B组获卵数明显高于C组(P<0.05)。随访9个月,3组患者在临床妊娠率、流产率及异位妊娠率相比较差异均无统计学意义(P>0.05)。结论输卵管伞端造口术、输卵管近端结扎远端造口术、输卵管切除术治疗IVF-ET患者输卵管积水均能够改善患者妊娠结局,但输卵管切除术影响卵巢功能使获卵数降低。

Objective To investigate the effect of different treatments of hydrosalpinx on pregnancy outcome in patients undergoing in vitro fertilization and embryo transfer（IVF-ET）.Methods One hundred and Iwenty-six cases were selected from June 2013 to October 2015 in Meizhou Peoples Hospital,two with tubal factor infertility underwent IVF-ET treatment,ET treatment according to IVF severity before patients with hydrosalpinx were divided into 3 groups,patients in group A（42 cases of mild tubal seeper） y the fallopian tube colostomy; patients in group B（fallopian tube） of 42 cases received moderate hydronephrosis by proximal tubfd ligation and distal stoma; patients in group C（42 cases of tubal severe hydronephrosis）received resection of ihe fallopian tube.Comparison of the 3 groups of patients before and after third menstrual six sex hormone index,antral follicle number,gonadotropin（Gn） dosage,treatment time,hGG injection on the level of E2,the number of oocytes,embryos,clinical pregnancy rale,abortion rate and ectopic pregnancy rate.Results Three groups of patients before and after third menstrual cycles in six different hormone index level and number of antral follicles had no statistical significance（P〉0.05）;the differences of six kinds of hormone level and ihe number of anlrd follicle index between the 3 group were not statistically signififant（ P〉0.05）.There was no significant difference in Gn dosage,medication time,E2 level and the number of embryos transferred between the 3 groups（ P〉0.05）.The number of oocytes in group A and group B was significantly higher than that in group C（P〈0.05）.After 9-month follow-up,There was no significant difference in clinical pregnancy rate,alxjrtion rate and etopics pregnanry rate between the 3 groups（ P〉0.05）.Conclusion Fallopian tube colostomy,proximal tubal ligation and distal stoma,tubal resection in the treatment of IVF-ET patients with hydrosalpinx were able to improve the outcome of pregnancy in palicnts willi tubal resection,but the effect of the number of oocytes decreased ovarian function.