输卵管积水预处理方式对试管婴儿助孕结局的影响

Effect of Hydrosalpinx Preconditioning on Pregnancy outcome of in Vitro Fertilization and Embryo Transfer

目的:探讨体外受精—胚胎移植(IVF-ET)前输卵管积水不同的预处理方式对患者助孕结局的影响。方法:回顾性分析2014年1月—2017年12月因输卵管积水就诊,且在输卵管手术后进行IVF-ET的不孕症患者86例,随机分为三组,A组行腹腔镜下输卵管切除术,共30例,B组行输卵管近端阻断术,共30例,C组行输卵管造口术,共26例,对比三组输卵管积水处理后的卵巢功能、妊娠结局。结果:三组患者术前AMH、术前窦卵泡个数(AFC)、术后AFC差异无统计学意义(P> 0. 05);术后A组AMH水平显著低于B组(P <0. 05),A、C两组间及B、C两组间差异无统计学意义(P> 0. 05); A组术后AMH、AFC显著低于术前,B、C两组术前术后AMH、AFC差异无统计学意义。三组患者Gn天数、获卵数、内膜厚度、移植胚胎数差异均无统计学意义(P> 0. 05); A组Gn总量显著多于C组(P <0. 05),A组与B组、B组与C组间Gn总量差异无统计学意义;三组间妊娠率差异无统计学意义(P> 0. 05),A组妊娠率比B、C两组高出10个百分点,仍具有临床指导意义。结论:输卵管积水预处理常用的三种术式,输卵管切除术对妊娠率有更加积极的影响;输卵管造口术或近端阻断术有利于卵巢功能。

Objective:To explore the effect of different preconditioning methods of hydrosalpinx on the pregnancy outcome of patients with IVF-ET.Methods:Retrospective analysis from January 2014 to December 2017,due to hydrosalpinx treatment,and in the fallopian tube after surgery in 86 cases of infertility patients with IVF-ET.It is randomly divided into 3 groups,Group A underwent tubal resection,a total of 30 cases,group B underwent proximal tubal occlusion,a total of 30 cases,group C underwent tubal stoma,a total of 26 cases.The ovarian function and pregnancy outcome of 3 groups after treatment of hydrosalpinx were compared.Results:There was no significant difference in AMH(preoperative),AFC(postoperative)and AFC(preoperative)between the 3 groups(P >0.05).The level of AMH(postoperative)in group A was significantly lower than that in group B(P<0.05),There was no statistical difference between the two groups of A,C and the two groups of B and C(P >0.05).AMH and AFC after operation in group A were significantly lower than that before operation.There was no significant difference in AMH and AFC between the two groups of B and C before and after operation.There was no significant difference in the number of Gn days,the number of eggs retrieved,the thickness of the endometrium and the number of embryos transferred between the 3 groups(P >0.05).The total amount of Gn in group A was significantly more than that of group C(P<0.05).There was no significant difference in Gn between A group and B group,B group and C group.There was no significant difference in pregnancy rate among the three groups of A,B and C.The pregnancy rate in group A was 10 percentage points higher than that in B and C two groups,Still has clinical guiding significance.Conclusion:Three commonly used methods of hydrosalpinx preconditioning.Salpingectomy has a more positive effect on the pregnancy rate;salpingostomy or proximal blockage is beneficial to ovarian function.