体外受精与胚胎移植前输卵管积水处理方式的探讨

目的:探讨体外受精与胚胎移植(IVF-ET)前输卵管积水的不同处理方式对IVF-ET结局的影响。方法:回顾分析2002年1月至2004年12月因输卵管因素不孕接受IVF-ET治疗的346个治疗周期的资料。按输卵管的情况分为4组,A组:输卵管阻塞,未发现输卵管积水者,共151个治疗周期;B组:IVF-ET前输卵管积水未行手术治疗者,共73个治疗周期;C组:IVF-ET前输卵管积水行输卵管伞端造口术者,共43个治疗周期;D组:IVF-ET前输卵管积水行输卵管切除术者,共79个治疗周期。结果:各组的临床妊娠率分别为48.34%、21.92%、34.88%、44.30%,异位妊娠率分别为1.37%、12.50%、6.67%、2.86%,种植率分别为20.36%、5.87%、12.28%、19.38%,B组的临床妊娠率及种植率较A组、D组明显降低,B组、C组的异位妊娠率均较A组、D组升高。结论:输卵管积水对IVF-ET的结局有负面影响,IVF-ET前输卵管积水,先行手术治疗,可改善IVF-ET的结局。较之输卵管造口术,输卵管切除术可减少异位妊娠的发生率及输卵管积水的复发率。

Management of hydrosalpinx before in vitro fertilization and embryo transfer

Objective:To evaluate the effect of salpingectomy and salpingostomy for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer(IVF-ET).Methods:The data of 346 cycles of IVF-ET,accomplished from January 2002 to December 2004,were analyzed retrospectively.The data were divided into four groups.Group A comprised 151 cycles:no hydrosalpinx had been found before IVF-ET.Group B comprised 73 cycles:hydrosalpinx without surgical procedure before IVF-ET.Group C comprised 43 cycles:salpingostomy had been performed for hydrosalpinx before IVF-ET.Group D comprised 79 cycles:salpingectomy had been performed for hydrosalpinx before IVF-ET.Results:The pregnancy rates in four groups were 48.34%,21.92%,34.88% and 44.30% respectively.The ectopic pregnancy rates in four groups were 1.37%,12.50%,6.67% and 2.86% respestively.The embryo implantation rates in four groups were 20.36%,5.87%,12.28% and 9.38% respestively.The pregnancy rate in Group B was much lower than that in Group A and Group D.The ectopic pregnancy rates in Group B and Group C were higher than that in Group A and Group D.Conclusion:Hydrosalpinx has adverse effect on the pregnancy result of IVF-ET.Appropriate procedure should be performed before IVF-ET and it may improve the outcome of IVF-ET.Compared with salpingostomy,salpingectomy may reduce ectopic pregnancy rate and the recurrence rate of hydrosalpinx.