不同手术方式处理卵巢子宫内膜异位囊肿对体外受精-胚胎移植妊娠结局的影响

Effect of different surgical methods for treatment of ovary endometriosis cysts on pregnancy outcome of assisted reproductive technology

目的探讨卵巢子宫内膜异位囊肿剔除术和经阴道穿刺抽吸术对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法选择2010年1月至2016年3月在我院行IVF-ET助孕治疗的98例卵巢子宫内膜异位囊肿患者为研究对象,根据助孕前处理不同分组:52例曾在外院接受囊肿剔除术的患者为囊肿剔除组,46例促排卵前行经阴道行囊肿穿刺抽吸术的患者为穿刺组;并选择同期来我院就诊因单纯输卵管因素不孕的55例患者为参照组。比较不同手术组的促排卵情况及妊娠结局,以及与本中心一般IVF患者的临床结局差异。结果穿刺组窦卵泡数显著低于参照组[(10.41±4.69)vs.(13.68±7.78)个](P<0.05)。囊肿剔除组和穿刺组的HCG日E_2水平[分别为(15 746.24±7 821.86)、(16 704.57±7 860.99)pmol/L]显著低于参照组[(21 082.45±10 316.09)pmol/L](P<0.05)。囊肿剔除组和穿刺组的获卵数[分别为(11.37±5.98)、(10.84±6.01)个]显著低于参照组[(14.05±7.27)个](P<0.05),但3组间双原核(2PN)受精率、优质胚胎率、移植胚胎数比较均无显著性差异(P>0.05)。穿刺组的临床妊娠率(39.13%)呈低于囊肿剔除组(53.85%)的趋势,但无显著性差异(P>0.05)。结论卵巢子宫内膜异位囊肿术后的IVF-ET临床结局与本中心一般IVF妊娠结局相似。卵巢子宫内膜异位囊肿行剔除术和穿刺术各有优势,在临床工作中应根据患者实际情况选择合适的治疗方式。

Objective： To investigate the effect of different modus operandi （ovarian endometriosis cystectomy vs. ultrasound-guided transvaginal puncture of ovarian cyst） on the clinical outcome of IVF-ET. Methods： A retrospective analysis was performed on clinical data of 98 infertile patients less than 40 years old with ovary endometriosis cyst following assisted reproductive technology （ART） treatment. According to different operating ways, these patients were divided into ovarian endometriosis cystectomy group （cystectomy group, n= 52） and ultrasound-guided transvaginal puncture of ovarian cyst group （puncture group, n=46）. Another 55 infertile patients caused by tubal faetor were recruited as the references （reference group）. Then the ovulation induction and pregnancy outcome were analyzed between the two operation groups,and compared with the general IVF patients. Results： The number of antral follicles in the puncture group was significantly lower than that in the reference group [（10. 41±4. 69） vs. （13. 68±7. 78）]（P〈0. 05）. The E2 levels on HCG day in the cystectomy group [-（15 746.24±7 821.86） pmol/L] and the puncture group [（16 704. 57 ± 7 860. 99） pmol/L] were significantly lower than those in reference group [（21 082.45±10 316.09） pmol/L] （P〈0.05）. The number of oocytes retrieved from the cystectomy group [（11.37±5.98）] and the puncture group [（10.84±6.01）] was significantly less than the reference group [（14.05± 7. 27）] （P〈0.05）. There were no significant differences in 2PN rate, the fertilization rate,the quality embryo rate and number of transplanted embryos among the three groups （P〉0.05）. The clinical pregnancy rate in the puncture group （39.13 %） was lower than that of cystectomy group （53.85 %）, but it was not significantly different （P〉0.05）. Conclusions： The clinical outcomes of IVF-ET in the patients after operation of ovarian endometriosis cyst are similar with the general IVF patients. Ovarian endometriosis cystectomy and ultrasound-guided transvaginal puncture of ovarian cyst have their own advantages, and the appropriate treatment method should be chosen based on the actual situation of patients in clinical work.