输卵管手术对体外受精-胚胎移植患者卵巢血流及反应性的影响

目的:探讨在体外受精-胚胎移植(IVF-ET)中输卵管手术对控制性超排卵(COH)患者卵巢的血流及卵巢储备功能的影响。方法:选择因异位妊娠或输卵管阻塞粘连行一侧输卵管切除或修复整形(单侧手术组)、双侧输卵管切除或双侧输卵管修复整形(双侧手术组)以及双侧输卵管均未行手术(对照组)的输卵管性不孕患者共70例,观察其在IVF-ET控制性超排卵中卵巢的血流变化及卵巢对COH的反应。结果:①3组患者的年龄、不育年限、用药天数及用药量均无统计学差异(P>0.05),单侧手术组术侧卵巢月经d3卵巢基质血流的搏动指数(PI)、收缩期峰流速(PSV)及hCG注射日(dhCG)PI与健侧卵巢差异无统计学意义(P>0.05)。但术侧卵巢d3血流阻力指数(RI)、RI(dhCG)明显大于健侧卵巢,PSV(dhCG)则明显小于健侧卵巢(P<0.05)。术侧卵巢的基础窦卵泡数(AFC)、dhCG≥14mm卵泡数以及获卵数明显少于健侧卵巢(P<0.05);②3组患者在d3的PI、RI、PSV,PI(dhCG)、RI(dhCG)差异无统计学意义(P>0.05)。但双侧手术组PSV(dhCG)明显低于对照组(P<0.05),其基础AFC、hCG注射日≥14mm卵泡数及获卵数也明显少于对照组(P<0.05)。结论:输卵管手术会影响卵巢的血运,降低卵巢的储备功能。

Effects of Operation on Fallopian Tube on Ovarian Blood Flow and Response in Vitro Fertilization and Embryo Transfer Program

Objective:To investigate the effects of operation on fallopian tube on ovarian blood flow and response to superovulation in vitro fertilization and embryo transfer program.Methods:The ovarian blood flow and responses to superovulation were evaluated in 70 patients with unilateral/bilateral salpingectomy or salpingoplasty for ec-topic pregnancy or salpingemphraxis and patients with tubal infertility with existing salpinx.Results(:1)There was no significant difference of age,infertility,years,time of medication and hormone dosage among the three groups(P>0.05),as well as pulsatility index(PI)and peak systolic blood flow velocity(PSV)on the third day of menstruation(d3)and the PI on the day of hCG(dhCG)between the operated side and contralateral side(P>0.05).But the resistance index(RI)was higher in the operated side than that in contralateral side on d3 and the day of hCG,the PSV was lower in the operated side than that in contralateral side on the day of hCG(P<0.05).The number of antral follicles,preovulative follicles and retrieved oocytes in the operated side was lower than that in contralateral side in unilateral operation on fallopian tube(P<0.05);(2)There was no significant difference of PI,RI,PSV on d3 and PI,RI on the day of hCG among the three groups(P>0.05),but the PSV(dhCG)was lower in group of bilateral operation on fallopian tube than that in the group of tubal infertility with existing salpinx(P<0.05).The antral follicles count,preovulative follicles and retrieved oocytes in group of bilateral operation on fallopian tube was lower than that in the group of tubal infertility with existing salpinx(P<0.05).Conclusion:Operation on fallopian tube influences ovarian function.The reason may be that operation impaired ovarian blood flow.