宫腹腔镜及联合辅助生殖技术治疗输卵管性不孕的妊娠结局及相关因素分析

发布时间：2018-05-09 12:47

  本文选题：输卵管性不孕 + 妊娠结局　； 参考：《郑州大学》2014年硕士论文

【摘要】：研究背景： 输卵管性不孕(Tubal factor infertility，TFI),是指由于各种因素形成输卵管管壁肌肉收缩功能及上皮纤毛蠕动减弱或输卵管粘连、积水及阻塞等，引起输卵管伞端拾取卵子及运送受精卵进入宫腔着床的功能丧失，导致女性不孕。近年来，一方面由于晚婚、晚育、人工流产次数的增加及性传播疾病的增加，输卵管性不孕的发病率有增高趋势；另一方面由于腹腔镜技术在女性不孕中应用的普及，输卵管因素在女性生育功能中的重要地位越来越受到关注。输卵管性不孕具有发病率高、病因多样、疗效欠佳的特点，其严重影响患者的身心健康和家庭和谐。 目前，输卵管性不孕常用的诊疗方法有输卵管通液术、子宫输卵管造影、宫腔镜插管通液术等。目前宫腹腔镜联合探查术被认为是输卵管性不孕诊疗的金标准。其治疗效果的差异跟病例选择及患者盆腔粘连、输卵管病变程度、输卵管通畅情况等有密切相关性。而IVF-ET的出现解决了输卵管性不孕患者精卵结合障碍的问题，且有较高的妊娠率，但花费较高。目前临床尚没有统一的治疗输卵管性不孕的标准，本研究回顾性分析宫腹腔镜联合辅助生殖技术治疗输卵管性不孕妊娠结局及相关因素，探讨如何改善输卵管性不孕的妊娠结局，为临床治疗提供参考。 目的：通过分析宫腹腔镜及联合辅助生殖技术治疗的输卵管性不孕患者，探讨其术后自然受孕率，术后最佳受孕时间、分析各影响因素与受孕率的关系，术后接受辅助生殖助孕的最佳时间。为临床医师综合输卵管性不孕患者的整体情况以指导患者掌握最佳的妊娠时机并获得最高妊娠率。 资料与方法： 1研究对象 2010年1月至2010年12月期间在郑州大学第三附属医院因输卵管性不孕住院行宫腹腔镜手术的426例患者,符合标准207例，在随访过程中，失访21例，共随访到186例纳入本研究，其中5例因输卵管妊娠切除患侧输卵管，共367条输卵管，其中原发不孕73例，继发不孕113例。 2研究方法 电话随访术后6个月、12个月、18个月的妊娠情况;根据术后是否自然受孕分为自然受孕组和未自然受孕组。6个月后未自然受孕组中，其中54例患者接受体外受精-胚胎移植(IVF-ET)，电话随访其是否受孕，根据其接受IVF助孕后是否妊娠分为IVF妊娠组和IVF未妊娠组。两组之间的观察指标包括患者一般资料如年龄、不孕年限、不孕类别；患者的既往手术史如人工流产史、盆腔手术史、输卵管妊娠史；患者行宫腹联合的术中情况包括盆腔粘连程度、输卵管积水程度(通过目测)、术中治疗后输卵管通畅情况。 3统计学方法 将相关变量进行编码后录入Excel表格。使用SPSS17.0统计软件分析数据，检验水准α=0.05，基本情况的比较用χ2检验、独立样本T检验。对影响妊娠结局的相关因素先进行单因素Logistic回归分析，将有统计学意义（P＜0.1）的因素引入多因素Logistic回归分析。 结果： 1.妊娠率：186例患者宫腹腔镜术后总自然受孕69例，总自然受孕率为37.10%（69/186）；宫腹腔镜术后6月内55例自然妊娠，术后0-6月自然受孕率为29.57%(55/186)；术后7月至12月之间12例自然受孕，术后0-12月内累计自然受孕率为36.02%(55+12/186)；12月后自然受孕2例，术后0-18月累计自然受孕率为37.10%(55+12+2/186)；宫腹腔镜术后6个月未自然受孕者行IVF的有54例患者，其中28例妊娠，IVF累计妊娠率为51.85%(28/54)。 2.宫腹腔镜术后自然受孕率影响因素的相关分析： 一般资料：单因素及多因素分析结果显示:年龄P0.05，回归系数β为-0.125；不孕年限P0.05，回归系数β为-0.281；不孕类别P0.05，回归系数β为-0.4；可以认为不孕年限是影响宫腹腔镜术后自然受孕率的负相关因素，在控制其他因素不变的条件下，随不孕年限的增长，自然受孕率下降。年龄和不孕类别不是自然受孕率的影响因素。 既往手术史：单因素及多因素分析结果显示:人工流产史P0.1，回归系数β为-0.229；盆腔手术史P0.1，回归系数β为-0.394；输卵管妊娠史P0.05，回归系数β为-1.871，卡方分析χ2为0.747，P0.05，差异无统计学意义；故人工流产史、盆腔手术史、输卵管妊娠史不是影响宫腹联合术后自然受孕率的影响因素。 术中情况：单因素及多因素分析结果显示：盆腔粘连P0.05，回归系数β为-0.98，卡方分析χ2为3.22，P0.05，差异有统计学意义；输卵管积水程度P0.05，回归系数β为-0.85，卡方分析χ2为0.27，P0.05，差异有统计学意义；输卵管通畅情况P0.05，回归系数β为0.743，卡方分析χ2为4.947，P0.05，差异有统计学意义；可以认为盆腔粘连程度、输卵管积水程度是影响自然受孕率的负相关因素，即在控制其他因素不变的条件下，随着盆腔粘连程度及输卵管积水程度的加重，自然受孕率降低。输卵管通畅情况是影响自然受孕率的正相关因素。即在控制其他因素不变的条件下，，输卵管双侧通畅的自然妊娠率高于单侧通畅的自然受孕率。 综上可知：不孕年限、盆腔粘连程度、输卵管积水程度是影响宫腹腔镜术后自然受孕率的负相关因素，输卵管通畅情况是正相关因素。 3.宫腹腔镜术后自然受孕失败行IVF妊娠率的影响因素的相关分析 一般资料：单因素及多因素分析结果显示:年龄P0.05，回归系数β为-0.473；不孕年限P0.05，回归系数β为-0.042；不孕类别P0.05，回归系数β为-0.048；可以认为年龄是影响IVF妊娠率的负相关因素，即在控制其他因素不变的条件下，随年龄增长，IVF妊娠率下降；不孕年限和不孕类别不是影响IVF妊娠率的相关因素。 既往手术史：单因素及多因素分析结果显示:人工流产史P0.1，回归系数β为-0.336；盆腔手术史P0.1，回归系数β为-0.357；输卵管妊娠史P0.1，回归系数β为-0.077;故人工流产史、盆腔手术史、输卵管妊娠史不是影响IVF妊娠率的影响因素。 术中情况：单因素及多因素分析结果显示：盆腔粘连P0.05，回归系数β为-0.457;输卵管积水程度P0.05，回归系数β为-0.95;输卵管通畅情况P0.05，回归系数β为-0.223；可以认为盆腔粘连程度、输卵管积水通畅情况不是影响IVF妊娠率的相关因素，输卵管积水程度是影响IVF妊娠率的负相关因素。即在控制其他因素不变的条件下，随着输卵管积水程度的加重，IVF妊娠率降低。由上可知，年龄、输卵管积水程度是影响术后自然受孕失败行IVF妊娠率的负相关因素。 结论： 1.输卵管性不孕患者行宫腹腔镜术后6月内自然受孕率最高，临床指导患者术后应尽早试孕，以获得最佳妊娠结局。 2.不孕年限较短、无盆腔粘连或程度较轻、无输卵管积水或程度较轻的输卵管性不孕患者行宫腹腔镜术后自然受孕率较高，可期待自然受孕；不孕年限较长、盆腔粘连程度较重、输卵管积水程度较重的患者行宫腹腔镜术后自然受孕率较低，术后6月内自然受孕失败的患者应尽快接受IVF-ET助孕治疗。 3.年龄较大、输卵管积水程度较重的患者宫腹腔镜术后自然受孕率及IVF-ET的妊娠率均较低，建议尽早行IVF-ET治疗。
[Abstract]:Research background:
Tubal factor infertility (TFI) refers to the loss of the muscle contraction function of the tube wall of the fallopian tube, the weakening of the peristalsis of the epithelial cilium or the oviduct adherence, water accumulation and obstruction, causing the loss of the function of the oviduct parachute to pick up the eggs and transport the fertilized eggs into the uterine cavity and cause the female infertility. In recent years, one party As a result of late marriage, late childbearing, the increase of the number of abortions and the increase of sexually transmitted diseases, the incidence of tubal infertility is increasing; on the other hand, the importance of fallopian tube factors in female fertility is becoming more and more important because of the popularization of laparoscopy in female infertility. The characteristics of high rate, various causes and poor curative effect seriously affect the patient's physical and mental health and family harmony.
At present, the common methods of diagnosis and treatment of tubal infertility are tubal fluid, hysterossalis, hysterossalis, and hysteroscopic intubation. The combined exploration of uterine laparoscopy is considered as the gold standard for tubal infertility diagnosis and treatment. The difference of the treatment effect is with the choice of the cases and the pelvic adhesion, the degree of fallopian tube and the unobstructed oviduct There is a close correlation between the situation and so on. And the emergence of IVF-ET solves the problem of oviduct infertility in patients with tubal infertility, with high pregnancy rate and high cost. There is no unified standard for the treatment of tubal infertility at present. This study reviewed the retrospective analysis of uterine laparoscopy assisted reproductive technology in the treatment of tubal infertility. To discuss how to improve the pregnancy outcome of tubal infertility, and provide reference for clinical treatment.
Objective: To explore the natural pregnancy rate, the best postoperatively, the relationship between the influence factors and the pregnancy rate, and the best time to receive the assisted reproductive pregnancy after the operation, and the overall situation of the patients with oviductal infertility. To guide patients to master the best timing of pregnancy and obtain the highest pregnancy rate.
Information and methods:
1 research objects
From January 2010 to December 2010, 426 cases of laparoscopic surgery for tubal infertility in the Third Affiliated Hospital of Zhengzhou University met the standard 207 cases. During the follow-up, 21 cases were lost and 186 cases were followed up to the study. 5 cases were cut off the fallopian tube due to tubal pregnancy and 367 fallopian tubes, of which the original was not. There were 73 cases of pregnancy and 113 cases of secondary infertility.
2 research methods
6 months, 12 months, 18 months of pregnancy after 6 months of telephone follow-up; according to whether natural pregnancy was divided into natural pregnancy group and unnatural pregnancy group unnaturally conceived group.6 months later, 54 patients received IVF - embryo transfer (IVF-ET), telephone follow-up was not conceived, according to whether the pregnancy was divided into IVF after IVF pregnancy. Pregnancy group and IVF ungestation group. The observation index between the two groups includes the patient general information such as age, infertile years, infertility category; the history of the patient's previous operation, such as abortion history, pelvic surgery history, tubal pregnancy history, patients with uterine abdominal operation including pelvic adhesion degree, the degree of hydrosalpinx (through visual examination), surgery Tubal patency after treatment.
3 statistical method
The related variables were encoded into the Excel form. Using the SPSS17.0 statistical software to analyze the data and test the level of the alpha =0.05, the basic situation was compared with the x 2 test and the independent sample T test. The single factor Logistic regression analysis was carried out for the related factors affecting the pregnancy outcome, and the factors of the overall planning significance (P < 0.1) were introduced into the multiple factor Logistic. Regression analysis.
Result锛

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