输卵管积水不同处理方式对体外受精-胚胎移植结局的影响：一项回顾性队列研究

Effects of different operation managements on in vitro fertilization and embryo transfer outcome: a retrospective cohort study

目的探讨输卵管积水的不同手术处理方式及术后积水复发对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)临床结局的影响。方法采用非随机分组数据,回顾性分析2012—2014年期间因输卵管因素在本中心行常规IVF-ET治疗的939例不孕患者的资料,按IVF-ET前每位患者的输卵管积水处理方式分为手术组(A组,n=533)和未处理组(B组,n=406)。手术组又分为输卵管近端结扎组(A1组,n=311)、输卵管造口组(A2组,n=113)和输卵管切除组(A3组,n=109),每例患者仅纳入本研究时间段内第一个新鲜胚胎移植周期的效果,比较积水患者不同手术方式对IVF-ET临床结局的影响。结果 A组的临床妊娠率(50.7%)和活产率(91.1%)均高于B组(40.4%,77.4%)(P<0.05);A组的异位妊娠率(3.7%)明显低于B组(12.8%)(P<0.05);控制性超促排卵(COH)过程中的获卵数、获胚胎数、优质胚胎数A、B组间均无统计学差异(P>0.05)。A1组、A2组及A3组间IVF-ET的临床妊娠率、活产率、流产率均无统计学差异(P>0.05),COH过程中获卵数、获胚胎数、优质胚胎数3个亚组间亦均无统计学差异(P>0.05)。结论输卵管积水通过手术处理可以提高其IVF-ET的临床妊娠率、活产率、降低异位妊娠率,并且进行输卵管造口、结扎、切除的不同处理对于IVF-ET结局和卵巢储备功能均无统计学影响。

Objective To evaluate and compare the clinical impact of different operation methods of hydrosalpinges when performed before in vitro fertilization and embryo transfer（IVF-ET） in patients with hydrosalpinges. Methods The data of 939 of infertile patients through tubal factors undergoing IVF-ET from 2012 to 2014 were analyzed retrospectively. All patients were divided into two groups according to the management of hydrosalpinx per person, 533 patients with hydrosalpinx in group A who were treated with operation while 406 patients with hydrosalpinx in group B were untreated. Group A were divided into three subgroups according to surgical methods, 311 patients with hydrosalpinx in group A1 who were treated with proximal tubal ligation, 113 patients with hydrosalpinx in group A2 who were treated with salpingostomy, 109 patients with hydrosalpinx in group A3 who were treated with salpingectomy. The clinical outcome of IVF-ET was evaluated. Results The clinical pregnancy rate（50.7%） and the live birth rate（91.1%） in group A were significantly higher than those in group B（40.4%, 77.4%, respectively）（P〈0.05）. The ectopic-pregnancy rate（3.7%） in group A was significantly lower than that in group B（12.8%）（P〈0.05）. There were no significant differences among group A1, group A2 and group A3. Conclusion Surgical of the fallopian tube, when performed in women with unilateral or bilateral hydrosalpinges before their IVF treatment, represents potential benefits—significantly increasing the clinical pregnancy rate and significantly decreasing the ectopic pregnancy rate. There is no significant difference of the ovarian reserve and IVF-ET outcome after salpingostomy, proximal tubal ligation or salpingectomy of the fallopian tube.