输卵管积水所致不孕症临床治疗分析

Clinical analysis of treatment of infertility caused by hydrosalpinx

目的探讨输卵管积水所致不孕症的临床治疗方法。方法选择2010年8月至2015年3月,东南大学(徐州)生殖医学研究所收治的144例输卵管积水所致不孕症患者为研究对象。对所有患者进行腹腔镜下输卵管造口术。对输卵管造口成功者,根据患者意愿选择是否进行体外受精-胚胎移植(IVF-ET);对输卵管造口失败者,根据患者意愿选择是否切除积水输卵管,并均进行IVF-ET治疗。所有患者临床治疗结束后电话随访3年,了解患者妊娠情况。采用t检验及χ~2检验,对不同病变范围及不同治疗措施的4种情况下,不孕症患者的一般临床资料(年龄、原发性不孕患者比例)及临床妊娠率进行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求,与所有受试者签署临床研究知情同意书。结果①本研究144例不孕症患者中,输卵管造口术成功为95例,44例自愿接受IVF-ET治疗;输卵管造口术失败为49例,均接受IVF-ET治疗,自愿选择切除积水输卵管者为15例。②输卵管造口术成功而未接受IVF-ET治疗的51例不孕症患者中,单侧与双侧输卵管积水者的临床妊娠率比较,差异无统计学意义(16.3%vs 12.5%,χ~2=0.000,P=1.000)。③输卵管造口术成功,并且接受IVF-ET治疗的44例不孕症患者中,单侧输卵管积水者临床妊娠率(72.7%),显著高于双侧者(36.4%),并且差异有统计学意义(χ~2=5.867,P=0.015)。④输卵管造口术失败而接受IVF-ET治疗的49例不孕症患者中,保留与切除积水输卵管者的临床妊娠率比较,差异无统计学意义(5.9%vs 26.7%,χ~2=2.474,P=0.116)。⑤接受IVF-ET治疗的93例不孕症患者中,输卵管造口术成功者的临床妊娠率(54.5%),显著高于失败者(12.2%),并且差异有统计学意义(χ~2=18.983,P<0.001)。结论对于输卵管积水所致不孕症,尤其是单侧输卵管积水者,宜采用输卵管造口术,并接受IVF-ET治疗。是否切除积水输卵管,可能对输卵管造口术失败后接受IVF-ET治疗的输卵管积水所致不孕症患者的疗效无影响。

Objective To investigate the clinical treatment methods for infertility caused by hydrosalpinx. Methods A total of 144 infertility women caused by hydrosalpinx from August 2010 to March 2015 in Institute of Reproductive Medicine (Xuzhou) of Southeast University were selected as research subjects. All the patients were performed laparoscopes salpingostomy. For patients with successful salpingostomy, the in vitro fertilization-embryo transfer (IVF-ET) were performed according to the patients′ wishes;For patients with failed salpingostomy, hydrosalpinx were resected based on the patients′ wishes, and IVF-ET treatment were carried out later. All the cases were followed up after clinic treatment finished for 3 years to get pregnant informations. Independent-samples t test and chi-square test were used to compare the general information (age, ratio of primary infertility patient) and clinical pregnancy rates in the four situations of different extent of diseas and different treatment strategies. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from all patients. Results ①A total of 95 patients of 144 research subjects were performed with successful salpingostomy, among which 44 patients received the IVF-ET according to the patients′ wishes. All the 49 cases with failed salpingostomy were accepted the IVF-ET treatment, among whom 15 cases were performed resection of hydrosalpinx based on the patients′ wishes.②There was no significant difference between unilateral and bilateral hydrosalpinx of the 51 patients those with successful salpingostomy and without IVF-ET treatment in clinical pregnancy rate (16.3% vs 12.5%,χ 2 =0.000, P =1.000).③In the 44 cases of successful salpingostomy and with IVF-ET treatment, the clinical pregnancy rate of unilateral hydrosalpinx patients was 72.7%, which was significantly higher than that of bilateral hydrosalpinx patients′ 36.4%, and the difference was statistically significant (χ 2 =5.867, P =0.015).④There was no significant difference between preserved and resected hydrosalpinx of the 49 patients those with failed salpingostomy and accepted IVF-ET treatment in clinical pregnancy rate (5.9% vs 26.7%,χ 2 =2.474, P =0.116).⑤In the 93 cases with IVF-ET treatment, the clinical pregnancy rate of successful salpingostomy patients was 54.5%, which was significantly higher than that of failed salpingostomy patients′ 12.2%, and the difference was statistically significant (χ 2 =18.983, P <0.001). Conclusions For infertility caused by hydrosalpinx, especially for unilateral hydrosalpinx patients, the appropriate treatment is salpingostomy combined with IVF-ET treatment. Preserved or resected hydrosalpinx may have no influence on therapeutic effect of hydrosalpinx infertility patient that with failed salpingostomy and accepted IVF-ET treatment.