输卵管手术对IVF-ET卵巢反应性及妊娠结局影响的研究  

Study of the Effects of Fallopian Tube Operation on IVF-ET Ovarian Response and Outcome

作　　者：易恬[1] 马兰[1] 杨晓玲[1] 范文[1] 孟昱时[1] 

机构地区：[1]昆明医科大学第二附属医院,云南昆明650101

出　　处：《实用妇产科杂志》2016年第8期597-601,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨输卵管手术对体外受精-胚胎移植(IVF-ET)过程中卵巢反应性和妊娠结局的影响。方法:接受IVF-ET治疗、符合纳入标准的650例不孕症患者共650个周期。曾因输卵管妊娠或输卵管阻塞、粘连或积水行输卵管切除术或修复整形手术的共304例,其中行输卵管切除术155例(A组),单侧输卵管切除126例(单侧输卵管切除组),双侧输卵管切除29例(双侧输卵管切除组);输卵管修复整形术149例(B组)。同期因输卵管因素不孕或单纯男方因素行IVF-ET者为对照组,346例。检测各组的性激素水平及AFC,比较卵巢反应性及妊娠结局。结果:1A组与对照组相比,低反应发生率增加(P<0.05),而B组与对照组相比差异无统计学意义(P>0.05)。2A组与对照组相比,基础促卵泡生成素(b FSH)、b FSH/黄体生成素(b LH)、雌二醇(b E2)水平均明显增高(P<0.01,P<0.05),B组b E2显著高于对照组(P<0.01)。3A组、B组与对照组相比,促性腺激素(Gn)天数延长(P<0.01,P<0.05)、Gn用量均增加(P<0.01),A组Gn天数长于B组(P<0.05)。3组间优质胚胎率、正常受精率、临床妊娠率、种植率和流产率差异均无统计学意义(P>0.05)。4单侧输卵管切除患者术侧卵巢与对侧卵巢比较,术侧卵巢的窦卵泡数与获卵数均明显减少(P<0.01)。5双侧输卵管切除组与单侧输卵管切除组相比,Gn天数延长,Gn用量增加(P<0.01)。结论:输卵管手术会影响卵巢储备功能和卵巢反应性,影响程度与手术范围和手术损伤程度有关,但不会明显影响IVF-ET的结局。Objective：To investigate the effects of fallopian tube operation on in vitro fertilization-embryo trans- fer（IVF-ET） ovarian response and outcome, and to provide some theoretical basis/foundation for clinical prac- tice. Methods：Totally,650 cycles of 650 infertile couples who received IVF-ET treatment and met the inclusion criteria. 304 cases had a history of tubal pregnancy,tubal occlusion,tubal adhesions or hydrosapinx and therefore salpingectomy or tubal repair plastic surgery were performed, of which 155 cases received salpingectomy （A group） ,Within 155 cases who received salpingectomy, 126 cases received unilateral salpingectomy（ unilateral sal- pingectomy group） and 29 cases received bilateral salpingectomy（bilateral salpingectomy group）. 149 cases received tubal repair plastic surgery to repair the fallopian tubes（ B group）. Over the same period of time,346 cases were enrolled as the control group who were also treated with IVF-ET simply due to tubal factors or male factors. Results：①Group A showed increase in the incidence of low ovarian response compared with control group（ P 〈 0.05）. But there was no difference on the incidence of low ovarian response between group B and control group. ②Compared with control group,A group had a significant increase in the level of bFSH, bFSH/bLH and bE2 （ P 〈 0.01, P 〈 0. 05）, B group had a significant increase in the bE2 level（ P 〈 0.01 ）. ③Compared with control group, group A and B extended the time length of Gn（ P〈0.01 ,P〈0.05） and upped the dosage of Gn（ P〈0.01 ）. Gn time of group A was longer than that of group B（ P 〈 0.05）. But no statistically significant difference was found in high-quality embryos rate, in vitro fertilization rate, clinical pregnancy rate, implantation rate and abortion rate a- mong the three groups（ P 〉 0.05）. ④Compared with the contralateral side ovary, the ovary received unilateral sal- pingectomy showed significant reduction in the number of antral follicles an

关 键 词：输卵管 体外受精-胚胎移植 卵巢反应性 妊娠结局 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]