辅助生殖技术取卵术后急诊并发症的诊断和治疗

Diagnosis and treatment of emergency complications after oocyte retrieval with assisted reproductive technology

目的回顾性分析经辅助生殖技术(assisted reproductive technology,ART)取卵术后患者发生急诊并发症情况和相应处理对策,为进一步减少辅助生殖技术急诊并发症提供可参考的资料。方法对2016年1月—12月接受ART助孕取卵术后的患者进行回顾性分析,对取卵术后急诊并发症出现情况进行分析。结果共纳入患者5 013例,取卵术后常见急诊并发症包括阴道出血137例(2.73%),卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)35例(0.69%),膀胱损伤导致的血尿11例(0.21%),盆腔感染3例(0.06%),迷走神经反射2例(0.04%)。其中,OHSS并发症最易误诊,其发生与年龄、基础窦状卵泡数目、获卵数目及注射人绒毛膜促性腺激素日雌二醇水平有关,而与体质量指数及促性腺激素使用天数无关。结论 OHSS是辅助生殖技术取卵术后常见和严重的急诊并发症之一,需加强对OHSS的认识。积极处理取卵术后相关并发症,有助于减少误诊及其急诊并发症的发生,提高ART的安全性。

Objective To retrospectively analyze the emergency complications of the patients after oocyte retrieval with assisted reproductive technology （ART）, and analyze the corresponding strategies. Methods The clinical data of patients after oocyte retrieval with ART between lanuary and December 2016 were retrospectively anayzed. The postoperative emergency complications were observed. Results A total of 5 013 patients were included in the study. The common emergency complications after oocyte retrieval included vaginal bleeding in 137 cases （2.73%） , ovarian hyperstimulation syndrome （OHSS） in 35 （0.69%）, hematuria caused by bladder injury in 11 cases （0.21%）, pelvic infection in 3 （0.06%）, and vagal reflex in 2 （0.04%）. OHSS was related to age, the number of basal follicles, the number of oviposaccharides and the estradiol level on the day of human chorionic gonadotropin injection, but not related to the body mass index and the number of days of gonadotropin use; which might be misdiagnosed most likely. Conclusions OHSS is one of the common and severe emergency complications after oocyte retrieval with ART, which should be concerned, Active treatment of complications is helpful to reduce the incidence of emergency complications after oocyte retrieval with ART.