腹腔镜下输卵管结扎与切除术对输卵管积水患者IVF妊娠结局分析

目的 比较腹腔镜下输卵管结扎术与输卵管切除术对输卵管积水患者体外受精胚胎移植(IVF-ET)助孕临床结局.方法 将南京大学医学院附属鼓楼医院生殖中心2012年1月至2014年12月IVF助孕前在国内三级医院行腹腔镜检查诊断输卵管积水的患者189例,根据腹腔镜下不同手术方式将患者分为两组,输卵管结扎术组(A组)89例和输卵管切除术组(B组)100例,比较两组患者年龄、术后卵泡生成素(FSH)、雌二醇(E2)、窦卵泡数(AFC)、身体质量指数(BMI)、获取成熟卵子数、胚胎冷冻数、胚胎植入率、临床妊娠率、流产率及异位妊娠率情况.结果 A组促排卵过程中促性腺激素(Gn)用量为(2189.06±844.75)IU,较B组(2451.37±782.30)IU明显偏低(t=2.199,P<0.05),A组胚胎植入率(45.14%)较B组(56.06%)明显偏低(χ2=4.431,P<0.05),A组流产率(25.00%)较B组(9.33%)明显增高(χ2=5.846,P<0.05).两组患者年龄、BMI、术后FSH、E2、AFC、获取成熟卵子数、冷冻胚胎数、多胎妊娠率相似,A组临床妊娠率(62.92%)较B组临床妊娠率(75%)低,但差异无统计学意义(χ2=3.230,P>0.05),A组异位妊娠率(5.35%)较B组(2.66%)高,但差异无统计学意义(χ2=0.632,P>0.05).结论 对于输卵管积水患者在IVF助孕前建议行腹腔镜下输卵管切除术.

Pregnancy outcomes in IVF of hydrosalpinx patients treated with laparoscopic tubal ligation or salpingectomy

Objective To compare the clinical pregnancy outcomes of hydrosalpinx patients treated with laparoscopic salpingectomy or tubal ligation prior to in vitro fertilization and embryo transfer ( IVF-ET ) .Methods A total of 189 patients diagnosed as hydrosalpinges by laparoscopy in tertiary hospitals prior to receiving IVF in reproductive center of Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2012 to December 2014 were divided into two groups , 89 cases in tubal ligation group ( group A) and 100 cases in salpingectomy group (group B) based on laparoscopic surgical types .Patients' age, postoperative follicle stimulating hormone (FSH) level, estradiol (E2), antral follicle count (AFC), body mass index (BMI), mature oocytes, number of frozen embryos, embryo implantation rate , clinical pregnancy rate , miscarriage rate and ectopic pregnancy rate were compared between two groups .Results Dose of gonadotropin (Gn) used in ovulation induction in group A was 2189.06 ±844.75IU, which was significantly lower than 2451.37 ± 782.30IU in group B (t =2.199, P<0.05).Implantation rate of group A (45.14%) was significantly lower than that in group B (56.06%) (χ2 =4.431, P<0.05).Miscarriage rate of group A (25.00%) was significantly higher than that in group B (9.33%) (χ2 =5.846, P<005).Patients' age, BMI, postoperative FSH, E2, AFC, number of mature oocyte, number of frozen embryos, rate of multiple pregnancy were similar between two groups .Rate of clinical pregnancy in group A (62.92%) was lower than that in group B (75%), but there was no statistical significance (χ2 =3.230, P>0.05).Rate of ectopic pregnancy in group A (5.35%) was higher than that in group B (2.66%) without statistical significance (χ2 =0.632,P >0.05).Conclusion Laparoscopic salpingectomy is recommended to hydrosalpinx patients prior to IVF .