输卵管远端梗阻患者腹腔镜术后的妊娠结局

目的探讨腹腔镜下输卵管不同分级及输卵管积水复发的妊娠结局。方法选择2010年6月—2011年10月在本院生殖中心因输卵管远端阻塞性不孕行腹腔镜手术的患者120例,术中对输卵管病变进行分级,依据术中情况选择输卵管造口术或输卵管根部灼断术,术后比较各级输卵管自然妊娠情况,比较Ⅰ、Ⅱ级及Ⅲ、Ⅳ级自然妊娠率,试孕失败后行体外受精-胚胎移植助孕治疗(in vitro fertilization and embryo transfer,IVF-ET)的妊娠情况,并分析影响输卵管分级的因素。计数资料采用χ2检验,P0.05为差异有统计学意义。结果严格按照评级标准评级后发现120例患者中Ⅰ级17例;Ⅱ级31例;Ⅲ级32例;Ⅳ级40例(其中8例行灼断术)。随访6~28个月,术后自然妊娠率分别为Ⅰ级47.06%(8/17)、Ⅱ级35.49%(11/31)、Ⅲ级6.25%(2/32)、Ⅳ级0(0/32)。Ⅰ、Ⅱ级妊娠率明显高于Ⅲ、Ⅳ级妊娠率,两者比较差异有统计学意义(χ2=17.199,P0.05);输卵管积水患者灼断后行IVF-ET助孕治疗组妊娠46.15%(6/13)明显高于灼断前IVF-ET助孕治疗组(7.69%,1/13),两者比较差异有统计学差义(χ2=4.887,P0.05),Ⅰ、Ⅱ级试孕12个月未孕者25例接受IVF-ET助孕治疗,孕9例(36.00%,9/25),Ⅲ、Ⅳ级IVF-ET治疗65例孕20例(30.76%,20/65),Ⅰ、Ⅱ级IVF-ET妊娠率与Ⅲ、Ⅳ级IVF-ET妊娠率比较,两者差异无统计学意义(χ2=1.768,P0.05)。结论对输卵管远端阻塞性不孕的患者行腹腔镜手术治疗时应在术中对输卵管状态进行评级,可根据评级结果选择不同的助孕方法。

Pregnancy outcomes in patients with distal tubal obstruction after laparoscopic surgery

Objective To discuss the pregnancy outcomes in different grading of fallopian tubes and in recurrent hydrosalpinx. Methods A total of 120 cases with infertility due to occlusion of the distal end of the fallopian tube undergoing laparoscopic surgery were selected in our center from June 2010 to October 2011.Fallopian tube abnormalities were graded during surgery,and salpingostomy or cauterization of the proximal portion of the fallopian tubes were performed accordingly.Pregnancy outcomes were compared postoperatively in patients with fallopian tube abnormalities of different grades,as well as those in patients with fallopian tube abnormalities of I -IV grade who failed to get pregnant and received IVF-ET.The related factors influencing grading were also analyzed.Count data were processed by X^2 test ,the result of P〈0.05 as statistically significant differences.Results According to the grading criteria, of 120 cases,17 were of grade Ⅰ ,31 of grade Ⅱ ,32 of grade m ,and 40 grade IV（8 cases undergoing cauterization）.After a 28-month follow-up,the rate of natural pregnancy was 47.06%（8/17） in cases of grade I postoperatively,35.48% （11/31） in grade Ⅱ ,6.25%（2/32） in grade m,and 0（0/32） in grade IV.The pregnancy rate was obviously higher in grade Ⅰ andⅡ than in grade m and IV,showing statistically significant difference（X^2=17.199,P〈0.05）.The pregnancy rate in cases of hydrosalpinx receiving cauterization prior to IVF-ET after was 7.69%（1/13）,which was significantly higher than that in cases of hydrosalpinx receiving IVF-ET prior to cauterization 46.15%（6/13）];and significant difference was found between them （X^2=4.887,P〈0.05）.Among 35 cases of grade I and I who failed to get pregnant for 12 months and then received IVF-ET,9 cases were pregnant （36.00%, 9/25）.Among 65 cases of grade Ⅲ and Ⅳ receiving IVF-ET,20 cases were pregnant（30.76%,20/65）,and there was no statistically significant difference （X^2=1.768,P〉0.05 ）.Conclusion Grading of fallopian tube should be performed for cases of infertility due to occlusion of the distal end of the fallopian tube undergoing laparoscopic surgery,and different assisted reproduction methods can be selected accordingly.