中国输卵管积水不孕患者IVF-ET术前输卵管切除预处理的必要性及安全性系统评价  

Salpingectomy before IVF-ET for Hydrosalpinx among Chinese Women:A Systematic Review

作　　者：赵静[1] 苟江[1] 李东红[1] 王蕴颖[1] 闫春芳[1] 罗莉[1] 杨英[1] 

机构地区：[1]西安市第四医院生殖医学科,西安710004

出　　处：《中国循证医学杂志》2011年第9期1039-1046,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价中国输卵管积水不孕患者体外受精-胚胎移植(IVF-ET)前输卵管切除预处理的必要性及安全性。方法计算机检索CBM、VIP、CNKI(均为2000～2010.12),查找中国输卵管积水不孕患者IVF-ET术前行输卵管切除术预处理的随机对照试验(RCT)。由两位研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价后,采用RevMan 5.0软件进行Meta分析。结果共纳入9个RCT,涉及输卵管积水不孕患者687例、累计730个IVF-ET周期,9个RCT的质量评级均为B级。Meta分析结果显示:中国输卵管积水不孕患者在IVF-ET术前行输卵管切除术预处理,①会增加超排卵时Gn用量[WMD=1.23,95%CI(0.17,2.30),P=0.02],但同时也增加了患者受精率[RR=1.07,95%CI(1.02,1.13),P=0.006]、卵裂率[RR=1.05,95%CI(1.00,1.09),P=0.03]及临床妊娠率[RR=1.92,95%CI(1.41,2.61),P<0.0001];②能降低流产率[RR=0.34,95%CI(0.13,0.86),P=0.002];③不影响Gn的刺激天数[WMD=–0.27,95%CI(–0.59,0.06),P=0.11]、HCG日E2水平[WMD=59.15,95%CI(–9.61,127.91),P=0.09]、获卵数[WMD=–0.27,95%CI(–0.44,0.99),P=0.46]、优质胚胎率[RR=1.02,95%CI(0.91,1.14),P=0.79]及异位妊娠率[RR=0.22,95%CI(0.03,1.82),P=0.16]。结论中国输卵管积水不孕患者在行IVF-ET术前做输卵管切除术预处理是必要且安全的。但由于纳入试验的方法学质量普遍偏低,因此期待更多设计合理的大样本随机双盲对照试验以提供更多高质量的证据。Objective To assess the necessity and effectiveness of salpingectomy before IVF-ET for hydrosalpinx among Chinese infertile patients.Methods The relevant papers published from 2000 to December of 2010 in China were electronically searched in CBM,VIP and CNKI to collect randomized controlled trials（RCTs） involving Chinese hydrosalpinx women with or without salpingectomy before IVF-ET.The quality of the included trials was independently assessed by two reviewers,and the data were extracted and analyzed by RevMan 5.0 so ware.Results Nine RCTs in-volving 687 patients and 730 IVF-ET cycles were identified.The results of meta-analyses showed that： a） There were signi cant differences between the two groups in Gn dosage（WMD=1.23,95%CI 0.17 to 2.30,P=0.02）,fertilization rate（RR=1.07,95%CI 1.02 to 1.13,P=0.006）,cleavage rate（RR=1.05,95%CI 1.00 to 1.09,P=0.03）,clinical pregnancy rate（RR=1.92,95%CI 1.41 to 2.61,P0.0001）,and abortion rate（RR=0.34,95%CI 0.13 to 0.86,P=0.002）;and b） ere were no signi cant differences between the two groups in days of Gn（WMD= –0.27,95%CI –0.59 to 0.06,P=0.11）,E2 in HCG day（WMD=59.15,95%CI –9.61 to 127.91,P=0.09）,number of eggs（WMD= –0.27,95%CI –0.44 to 0.99,P=0.46）,quality embryonic rate（RR=1.02,95%CI 0.91 to 1.14,P=0.79）,and ectopic pregnancy rate（RR=0.22,95%CI 0.03 to 1.82,P=0.16）.Conclusion The current evidence shows that salpingectomy before IVF-ET for hydrosalpinx Chinese hydrosalpinx patients is necessary and effective.For the low quality of methodology of the included studies,more reasonably-designed and double-blind RCTs with large sample are required to provide more high-quality proof.

关 键 词：输卵管积水 体外受精-胚胎移植/IVF-ET 输卵管切除术 安全性 随机对照试验 系统评价 Meta分析 

分 类 号：R714.8[医药卫生—妇产科学]