影响腹腔镜下输卵管修复联合防粘连剂术后妊娠率和妊娠结局的多因素分析  

Multivariate Analysis of the Pregnancy Rate and Outcomes after Using Anti-adhesion Agents during Laparoscopic Fimbrioplasty/Neosalpingostomy

作　　者：肖丽[1] 沈利聪[1] 黄薇[1] 王秋毅[1] 朱慧莉[1] 刘冬[1] 雷海科[1] 

机构地区：[1]四川大学华西二院妇产科,成都610041

出　　处：《中国微创外科杂志》2012年第7期627-630,634,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨影响输卵管性不孕患者行腹腔镜输卵管修复联合防粘连剂术后妊娠率和妊娠结局的因素,比较术中使用氧化可再生纤维素膜(Interceed)与医用透明质酸钠凝胶(欣可聆)对术后妊娠的影响。方法随访我院2009年5月～2010年5月因输卵管性不孕行腹腔镜下输卵管修复整形术的172例的妊娠率和妊娠结局,对影响输卵管性不孕术后妊娠的有关因素(包括年龄、不孕年限、既往腹腔镜手术史、不孕类型、术前子宫输卵管碘油造影提示的输卵管通畅情况、术中亚甲蓝通畅情况、输卵管盆腔分度)进行多因素Logistic回归分析。并根据术中使用的防粘连剂分为Interceed组和欣可聆组,比较2组术后妊娠率及妊娠结局。结果 172例中术后妊娠46例,妊娠率26.7%(46/172)。其中异位妊娠7例,自然流产4例,活产率76.1%(35/46)。172例中输卵管盆腔病变轻度、中度、重度的妊娠率分别为50.0%(7/14)、32.9%(27/82)和15.8%(12/76)(χ2=10.120,P=0.006),其余各项因素均无显著性。经Logistic多因素回归分析,输卵管盆腔病变分度是影响术后妊娠率的主要因素(Waldχ2=9.494,P=0.002)。Interceed组和欣可聆组的妊娠率分别为27.9%(24/86)和25.6%(22/86)(χ2=0.119,P=0.730),活产率分别为79.2%(19/24)和72.7%(16/22)(χ2=0.262,P=0.609),差异均无显著性。结论输卵管盆腔病变分度是术后妊娠的主要影响因素,输卵管性不孕腹腔镜术中使用Interceed或欣可聆患者的妊娠结局无差异。Objective To compare the effects of oxidized regenerated cellulose adhesion barrier （Interceed） and hyaluronic acid gel （Singelean） that are used during laparoscopie fimbrioplasty/neosalpingostomy on the postoperative pregnancy rate and outcomes in patients with tubal factor infertility. Methods The postoperative pregnancy rate （PT） and pregnancy outcomes of 172 patients with tubal factor infertile, who received laparoscopic fimbrioplasty/neosalpingostomy from May 2009 to May 2010 in our hospital, were followed up. The patients were divided into Interceed and Singclean groups with 86 patients in each. The factors that influence postoperative pregnancy of patients with tubal factor infertility, including age, duration of infertility, history of laparoseopic surgery, type of infertility, preoperative fallopian tube patency tested by iodized oil, and the intraoperative tubal patency tested by methylene blue, and the grading of tubal and pelvic lesions, were analyzed with Logistic regression. Results Among the 172 patients, 46 patients were pregnant （rate of PT： 26.7% ）, including 7 cases of ectopic pregnancy, 4 cases of natural abortion, and 35 live birth （live birth rate： 76.1% ）. The rate of PT was significantly different among the patients with mild, moderate, and severe tubal and pelvic lesions [ 50.0% （7/14）, 32.9% （27/82） and 15.8% （ 12/76）, X^2 = 10. 120, P = 0. 006 ]. Logistic regression analysis revealed that PT was significantly related to the grading of tubal and pelvic lesions （ Wald test ： X^2 = 9. 494, P = 0. 002 ）. No significant difference was found in the rates of PT and live birth rate between the Interceed and Singclean groups [ 27.9% （24/86） vs, 25.6% （22/86）,X2=0.119, P=0.730; 79.2% （19/24） vs. 72.7% （16/22）,X2 =0.262, P=0.609]. Conclusions The grading of tubal and pelvic lesions is the main factor influencing postoperative pregnancy of tubal factor infertile patients. There is no difference between Interceed and Singclean in improving fe

关 键 词：输卵管性不孕 妊娠 Interceed 欣可聆 

分 类 号：R713.5[医药卫生—妇产科学]