输卵管积水不同处理方式及术后复发对IVF-ET结局及卵巢储备功能的影响

发布时间：2018-04-10 11:10

本文选题：输卵管积水 + 积水复发　；参考：《山东大学》2017年硕士论文

【摘要】：背景体外受精-胚胎移植技术(In vitro fertilization-Embryo transfer IVF-ET)最初是为了治疗输卵管原因引起的不孕,但是输卵管积水可以显著降低IVF-ET临床结局。目前输卵管积水在治疗的选择上主要有:B超引导下积水抽吸术,输卵管远端造口术,宫腔镜下输卵管间质部栓堵术,输卵管远端造口近端结扎术,输卵管切除术等。目前最主要的处理方式是输卵管切除术,但对于输卵管远端造口 +近端结扎术的研究尚不多。输卵管近端结扎术后存在输卵管积水复发的风险,这种情况下,积水复发是否对IVF-ET结局产生不良影响也缺乏研究。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卵巢功能及体外受精-胚胎移植(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年至2014年因输卵管因素在本中心行常规IVF/ICSI-ET治疗的939名不孕患者的资料,按IVF-ET前每位患者的输卵管积水处理方式分组。输卵管近端结扎组311名(A组);输卵管造口组113名患者(B组);输卵管切除组109名患者(C组);输卵管未处理组406名患者(D组)。将结扎组术后发现复发87人(A1组),未复发224人(A2组)每位患者的只取本研究时间段内第一个鲜胚移植周期,比较积水患者不同手术方式对IVF-ET临床结局的影响。结果1.结扎组的临床妊娠率(157/311、50.50%)、活产率(144/157,91.7%)均高于积水未处理组临床妊娠率(164/406,40.4%)、活产率(127/164,77.4%)(P0.05)。2.异位妊娠率(3/157,1.9%)结扎组明显低于未处理组(21/164,12.8%)(P0.05)。3.造口组和未处理的IVF-ET的结局相关指标无显著性差异(P0.05)。4.结扎组的窦卵泡数(12.4±6.0)高于切除组窦卵泡数(12.0±4.9),切除组Gn用量(2160.3±794.1)高于结扎组(2111.1±762.6),但是差别无统计学意5.结扎组和切除组的IVF-ET的相关指标无显著差异。6.输卵管积水结扎后未复发组(A1)和复发组(A2)的IVF-ET相关指标,流产率(Al=7.14%、A2=6.09%),生化妊娠率(Al=4.60%、A2=4.9),A1组均小于 A2 组,临床妊娠率(Al=49.8%、A2=46.3%)异位妊娠率(Al=4.8%、A2=0.9%)A1组大于 A2组,但是P0.05无显著统计学差异。结论1.输卵管近端结扎术可显著提高临床妊娠率及活产率,显著降低流产率和异位妊娠率。2.单纯输卵管造口术并不能显著提高输卵管积水患者的临床妊娠率。3.输卵管切除术与输卵管结扎术相比并没有显著影响卵巢的功能。4.输卵管积水结扎后积水复发不影响IVF-ET结局,对于已行输卵管结扎术者,即便积水复发,也不会对IVF结局产生显著不良影响。
[Abstract]:Background in vitro fertilization-Embryo transfer IVF-ETs were originally designed to treat infertility caused by fallopian tubes, but hydrosalpinx can significantly reduce the clinical outcome of IVF-ET.At present, the treatment of hydrosalpinx mainly includes: B ultrasonic guided drainage, distal oviduct ostomy, hysteroscopic interstitial tubal occlusion, distal tubal ligation, salpingotomy and so on.At present, the main treatment is salpingotomy, but there are few researches on distal tubal ligation.There is a risk of recurrence of hydrosalpinx after proximal tubal ligation.Objective to investigate the effects of different surgical management methods and recurrence of hydrosalpinx on ovarian function and IVF-ETs outcome in vitro fertilization and embryo transfer.Methods the data of 939 infertile patients who were treated with conventional IVF/ICSI-ET in our center from 2012 to 2014 due to fallopian tube factors were analyzed retrospectively with non-randomized data. Each patient was divided into three groups according to the management of hydrosalpinx before IVF-ET.311 patients in group A, 113 patients in group B, 109 patients in group C and 406 patients in group D of salpingostomy were treated with oviduct ligation (group A), group B (n = 113), group C (n = 109), group D (n = 406).In the ligation group, 87 cases of recurrence were found in group A 1 and 224 cases in group A 2) the first fresh embryo transplantation cycle was only taken from each patient in this study period to compare the effect of different surgical methods on the clinical outcome of IVF-ET in patients with hydronephrosis.Result 1.The clinical pregnancy rate in the ligation group was 15.7 / 31150.50 and the live birth rate was 14.4 / 1571.7respectively, which was higher than the clinical pregnancy rate of 16.4 / 406c40.4in the untreated group, and the live birth rate was 127- / 164c77.4and P0.055.2.The clinical pregnancy rate of the ligation group was higher than that of the untreated group.Ectopic pregnancy rate was significantly lower in the ligation group than in the untreated group (21 / 164 / 12. 8) P 0.05 / 3.The rate of ectopic pregnancy was significantly lower in the ligation group than in the untreated group.There was no significant difference in the outcome of IVF-ET between the ostomy group and the untreated group (P 0.05. 4).The number of antral follicles in ligation group (12.4 卤6.0) was higher than that in excision group (12.0 卤4.9), and the dosage of Gn in resection group (2160.3 卤794.1) was higher than that in ligation group (2111.1 卤762.6), but there was no significant difference.There was no significant difference in IVF-ET between ligation group and resected group.Conclusion 1.Proximal tubal ligation can significantly increase the clinical pregnancy rate and live birth rate, significantly reduce abortion rate and ectopic pregnancy rate.Salpingostomy alone can not significantly improve the clinical pregnancy rate of hydrosalpinx.Salpingotomy had no significant effect on ovarian function compared with tubal ligation.The recurrence of hydrosalpinx after ligation of hydrosalpinx did not affect the outcome of IVF-ET. For those who had undergone tubal ligation, the recurrence of hydronephrosis would not have a significant adverse effect on the outcome of IVF.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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