腹腔镜下输卵管积水处理方式对卵巢储备功能及体外受精-胚胎移植的影响

发布时间：2018-08-09 17:31

【摘要】：目的探讨腹腔镜下输卵管积水的不同处理方式对超促排卵中卵巢储备功能和体外受精-胚胎移植(IVF-ET)新鲜周期移植成功率的影响。方法选择因输卵管性因素不孕在我院辅助生殖中心就诊的322例不孕症患者,对其进行回顾性分析,并按年龄进行分层分析(分为25~30岁、30~35岁及35~40岁)。试验分两步,第一步研究卵巢的储备功能,以每侧卵巢为研究对象,根据输卵管积水的不同处理方式将患者分为腹腔镜下双侧输卵管切除术组(A组,n=77)、腹腔镜下双侧输卵管开窗术组(B组,n=83)、双侧输卵管阻塞或通而不畅而无积水组(C组,n=162),比较各组在基础窦状卵泡数、卵巢体积、促排1个周期后注射人绒毛膜促性腺激素(HCG)当日的成熟卵泡数的差异。第二步比较移植成功率,剔除因其他因素导致无法行新鲜周期移植的患者后,将行IVF-ET的患者分为腹腔镜下双侧输卵管切除术组(D组,n=49)、腹腔镜下双侧输卵管开窗术组(E组,n=73)、双侧输卵管阻塞或通向不畅而无积水组(F组,n=142),比较各组在注射HCG当日子宫内膜厚度及移植成功率的差异。其中,各组按照年龄层次将25~30岁、30~35岁、35~40岁的患者对应细分为3个亚组。结果 A1组、B1组与C1组相比,A2组、B2组与C2组相比,B3组与C3组相比,在基础窦状卵泡数、卵巢体积、成熟卵泡数方面均无统计学差异(均P0.05);但A3组与C3组比较,在基础窦状卵泡数、成熟卵泡方面的差异有统计学意义(均P0.05)。在移植成功率方面,各年龄患者中D、E、F 3组比较均无统计学差异(均P0.05)。结论腹腔镜下输卵管积水切除术降低35岁以上患者的卵巢储备功能,影响超促排卵时卵巢的反应性。对有行IVF-ET倾向的高龄输卵管积水患者,腹腔镜下输卵管开窗术可能是一种更理想的选择。
[Abstract]:Objective to investigate the effects of different treatments of hydrosalpinx under laparoscope on ovarian reserve function and success rate of fresh cycle transplantation of in vitro fertilization and embryo transfer (IVF-ET). Methods 322 infertile patients with infertility due to fallopian tube factors were retrospectively analyzed and divided into 2530 and 3540 years old according to their age. The experiment was divided into two steps. The first step was to study the reserve function of the ovary. According to the different management of hydrosalpinx, the patients were divided into two groups: laparoscopic bilateral salpingotomy group (group A), laparoscopic bilateral salpingotomy group (group B), bilateral tubal obstruction or obstruction without hydrosalpinx (group C). To compare the number of antral follicles in each group. Ovarian volume and the number of mature follicles on the day of injection of human chorionic gonadotropin (HCG) after 1 cycle of ovulation. The second step was to compare the transplant success rate, excluding patients who were unable to perform fresh cycle transplantation because of other factors. Patients with IVF-ET were divided into laparoscopic bilateral salpingotomy group (group D), laparoscopic bilateral salpingotomy group (group E) and bilateral tubal obstruction or obstruction without water (group F). The difference of endometrial thickness and successful rate of transplantation. According to the age group, the patients aged 25 to 30 years old and 35 to 35 years old were subdivided into three subgroups. Results there was no significant difference in the number of basal antral follicles, ovarian volume and mature follicles between group A _ 2 and C _ 2 compared with C _ 2 and C _ 3 groups (P0.05), but there was no significant difference between A3 group and C _ 3 group in the number of basal antral follicles, ovarian volume and mature follicles (P0.05). There were significant differences in the number of basic antral follicles and mature follicles (P0.05). In terms of success rate of transplantation, there was no significant difference in DG E F 3 group among all age groups (P0.05). Conclusion Laparoscopic hydrosalpingotomy reduces ovarian reserve function in patients over 35 years of age and affects ovarian reactivity in patients with hyperstimulation of ovulation. Laparoscopic salpingostomy may be a better choice for elderly patients with hydrosalpinx who are prone to IVF-ET.
【作者单位】：中国医科大学附属盛京医院妇产科;抚顺矿务局总医院妇产科;
【分类号】：R714.8

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