体外受精-胚胎移植前输卵管积水的治疗

The treatment of hydrosalpinx before in vitro fertilization and embryo transplant

目的比较输卵管介入栓塞术与腹腔镜下切除术两种方法在体外受精-胚胎移植(IVFET)术前治疗输卵管积水的效果与优缺点。方法选取因输卵管性不孕行IVF-ET患者170例,进行回顾性分析。分为3组:介入栓塞组65例,行积水输卵管介入栓塞术;腹腔镜下切除组55例,行腹腔镜下积水输卵管切除术;对照组50例,双侧输卵管近端阻塞,无积水的患者,直接行IVF-ET。结果 3组的促性腺激素(gonadotropin,Gn)的用量、HCG注射日E2值、HCG注射日卵泡数、获卵数、受精率、卵裂率、临床妊娠率、流产率、异位妊娠率比较差异均无统计学意义(P>0.05),介入栓塞组和腹腔镜下切除组成功率均为100%,无严重并发症发生。介入栓塞组门诊即可完成,手术时间短,无需麻醉,费用低是其优点。结论输卵管介入栓塞术和腹腔镜下切除术在IVF-ET术前治疗输卵管积水同样有效,均可改善妊娠结局,两者相比较,介入栓塞术方法更简便、安全,经济,效果确切,值得作为治疗的首选方法。

Objective To treat hydrosalpinx by using interventional embolization of fallopian tube or laparoscopic salpingectomy before the performance of auxiliary reproductive technology, i.e. in vitro fertilization and embryo transplant （IVF-ET）, and to compare the clinical effect, technical advantages and disadvantages between the two methods. Methods A total of 170 patients with tubal infertility who had received IVF-ET were selected, the clinical data were retrospectively analyzed. The patients were divided into three groups： （1） interventional embolization group （n=65）, using interventional cmbolization for hydrosalpinx; （2） laparoscopic salpingectomy group （n=55）, adopting laparoscopie salpingectomy for hydrosalpinx; and （3） control group （n=50） ： for these patients bilateral proximal fallopian tube obstruction was performed, and IVF-ET was directly carried out if the patient had no hydrosalpinx. Results No statistically significant differences in the used dosage of gonadotropin （Gn）, E2 level on HCG-injection day, the number of follicles on HCG-injection day, the number of retrieved oocytes, the fertilization rate, cleavage rate, clinical pregnancy rate, abortion rate, and ectopic pregnancy rate existed between each other among the three groups （P〉0.05）. The technical success rate in both interventional embolization group and laparoscopic salpingectomy group was 100%. No severe complications occurred. The interventional embolization procedure had some advantages, it could be completed at clinic room, the operation time was short, no anesthesia was needed, the medical cost was low, etc. Conclusion Interventional embolization of fallopian tube and laparoscopic resection are equally effective in treating hydrosalpinx before IVF-ET is conducted. Both methods can improve pregnancy outcome, but interventional embolization method is more simple, safe, economical and effective, which deserves to be the prefecTed melhod of treat,nent.