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体外受精胚胎移植前 3 种处理输卵管积液方法的比较

鲁景元,徐文健   

  1. 南京市妇幼保健院介入科
  • 收稿日期:2014-04-09 修回日期:2014-05-29 出版日期:2014-11-15 发布日期:2014-11-15
  • 通讯作者: 鲁景元

Comparison of Efficacy of Three Methods to Deal with Hydrosalpinx before in vitro Fertilization and Embryo Transfer

LU Jing yuan,XU Wen jian   

  1. Department of Intervention, Nanjing Maternity and Child Health Hospital， Nanjing Medical University
  • Received:2014-04-09 Revised:2014-05-29 Published:2014-11-15 Online:2014-11-15
  • Contact: LU Jing yuan

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摘要：

【摘要】 目的 探讨体外受精与胚胎移植（IVF-ET）前输卵管积液的 3 种不同处理方式对 IVF-ET 结局的影响。 方法 回顾分析 2011 年 1 月—2013 年 12 月因输卵管因素不孕（输卵管积液）而接受 IVF-ET 治疗的 731 个治疗周期的资料。 按移植前输卵管积液的处理方式分为 4 组： 输卵管介入栓塞组（栓塞组）， 共 257 个治疗周期； 腹腔镜输卵管伞端造口组（造口组）： 共 193 个治疗周期； 腹腔镜输卵管切除组（切除组）： 共 198 个治疗周期； 对照组， 即移植前未针对输卵管积液做任何处理， 共 83 个治疗周期。 结果 在控制性超排卵主要指标（窦卵泡数、促性腺激素用量、获卵数）比较中， 栓塞组、造口组及对照组均优于切除组； 在 IVF-ET 主要指标（胚胎植入率、临床妊娠率、流产率）比较中， 栓塞组、切除组优于造口组， 而造口组又优于对照组； 在输卵管妊娠率比较中， 则是栓塞组、切除组最低，造口组次之， 对照组最高。 结论 移植前针对输卵管积液的 3 种处理方法均对 IVF-ET 的结局有积极影响， 其中输卵管介入栓塞术与其他 2 种方法相比有一定优势。

关键词: 受精, 体外, 胚胎移植, 输卵管积液, 输卵管介入栓塞, 腹腔镜输卵管伞端造口, 腹腔镜输卵管切除

Abstract:

[Abstract]   Objective   To compare three different curative effects on hydrosalpinx before in vitro fertilization and
embryo transfer (IVF-ET).   Methods   Patients receiving IVF-ET between January 2011 to December 2013 (n=731) due to tubal factor infertility (hydrosalpinx) were retrospectively analyzed. All patients were divided into four groups. Embolization group underwent fallopian tube embolization (n=257). Colostomy group underwent laparoscopic tubal umbrella end colosto?my (n=193). Excision group underwent laparoscopic tubal excision(n=198). Control group did not undergo any effusion before transplantation (n=83).   Results   Comparing main indicators of ovarian hyperstimulation (the number of antral follicles, the dosage of gonadotropin (Gn), the number of retrieved oocytes), indicators were better in embolism group, colostomy group and control group than those in excision group. Comparing main indexes of IVF-ET (embryo implantation rate, clinical pregnancy rate, abortion rate), indicators were better in embolism group, excision group than those in colostomy group while indi?cators in colostomy group were better than those in control group. The pregnancy rate in fallopian tube was the lowest in em?bolism group and excision group, and the highest in control group.   Conclusion   All three methods of processing hydrosal?pinx before transplantation ended with positive impact on IVF-ET, and fallopian tube embolization has certain advantages over the other two treatment measures.

Key words: fertilization in vitro, embryo transfer, hydrosalpinx, fallopian tube embolization, laparoscopic tubal um?brella end colostomy, laparoscopic tubal excision