输卵管切除术对IVF-ET促排卵中卵巢反应性的影响  

Effect of salpingectomy on ovarian responsiveness to ovulation induction during IVF-ET

作　　者：张莹莹[1] 杨洁[1] 肖国宏[1] 夏承来[2] 余波澜[1] ZHANG Ying-ying;YANG Jie;XIAO Guo-hong;XIA Cheng-lai;YU Bo-lan(Reproductive Medicine Center,the Third Affiliated Hospital of Guangzhou Medical University,Key Laboratory for Reproductive Medicine of Guangdong Province,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes,Key Laboratory for Major Obstetric Diseases of Guangdong Province,Guangzhou 510150;Foshan Affiliated Women-Children Hospital of South Medical University,Foshan 528000)

机构地区：[1]广州医科大学附属第三医院生殖医学中心广东省生殖医学重点实验室广东省普通高校生殖与遗传重点实验室广东省产科重大疾病重点实验室,广州510150 [2]南方医科大学附属佛山妇幼保健院,佛山528000

出　　处：《生殖医学杂志》2019年第3期216-220,共5页Journal of Reproductive Medicine

基　　金：国家重点研发项目(2016YFC1000303)

摘　　要：目的探讨输卵管切除术对卵巢储备功能的影响,分析其对后续欲行体外受精-胚胎移植(IVF-ET)患者卵巢反应性和妊娠结局的影响。方法回顾性分析广州医科大学附属第三医院生殖医学中心因输卵管因素行IVF-ET治疗的不孕症患者682例(共815个周期)的资料,根据行控制性促排卵方案(COH)治疗前是否进行过输卵管切除手术将患者分为3组:双侧切除组(双侧输卵管因积水行手术切除)、单侧切除组(单侧输卵管切除,对侧输卵管阻塞)、双侧阻塞组(双侧输卵管均因积水阻塞,无手术史)。比较各组患者的临床资料、实验室结果及妊娠结局。结果双侧阻塞组的抗苗勒管激素(AMH)显著高于双侧切除组[(4.72±2.76)vs.(3.72±2.25)ng/ml],基础窦卵泡数(AFC)[(16.74±8.57)个]显著高于单侧切除组和双侧切除组[分别为(15.26±5.00)和(13.30±3.76)个];双侧阻塞组和单侧切除组的可利用胚胎率(分别为74.67%和75.41%)、优质胚胎率(分别为29.63%和31.61%)显著高于双侧切除组(可利用胚胎率67.00%,优质胚胎率25.21%);双侧阻塞组和单侧切除组的流产率(分别为4.07%和2.67%)显著低于双侧切除组(10.39%)(P均<0.05)。结论输卵管切除术可能会降低卵巢功能及胚胎质量,增加流产率。因此,输卵管因素不孕症患者在行IVF-ET治疗前,应尽量不行输卵管切除术,可考虑保守性手术或先取卵后手术治疗,以减少对卵巢功能及胚胎质量的影响。Objective:To investigating the effect of salpingectomy on ovarian reserve function and ovarian reactivity and pregnancy outcome of IVF-ET.Methods:The data of 682 patients with tubal factor infertility(815 cycles)undergone IVF-ET treatment in our hospital were retrospectively analyzed.The patients were divided into three groups according to whether they had salpingectomy or not:bilateral salpingectomy group(surgical removal of bilateral fallopian tubes due to hydrosalpinx,77 patients with 98 cycles),unilateral salpingectomy group(unilateral salpingectomy and contralateral fallopian tube obstruction,187 patients with 220 cycles),bilateral tubal obstruction group(without salpingectomy,418 patients with 497 cycles).The clinical data,laboratory results and pregnancy outcome were compared among the groups.Results:The AMH level of bilateral tubal obstruction group was significantly higher than that in bilateral salpingectomy group[(4.72±2.76)vs.(3.72±2.25)ng/ml],and AFC was significantly higher[(16.74±8.57)]than those in bilateral salpingectomy group and unilateral salpingectomy group[respectively(15.26±5.00)and(13.30±3.76)](P<0.05).The available embryo rate(74.67%and 75.41%)and good quality embryo rate(29.63%and 31.61%)in bilateral tubal obstruction group and unilateral salpingectomy group were significantly higher than those in bilateral salpingectomy group(available embryo rate 67.00%,good quality embryo rate 25.21%)(P<0.05).The abortion rate in bilateral tubal obstruction group and unilateral salpingectomy group(respectively 4.07%and 2.67%)was significantly lower than that in bilateral salpingectomy group(10.39%)(P<0.05).Conclusions:Salpingectomy may reduce ovarian function and embryo quality and increase abortion rate.Therefore,the patients with tubal infertility should avoid salpingectomy before the treatment of IVF-ET.Conservative surgery or retrieval of oocyte first and then surgery can be considered in order to reduce the impact on ovarian function and embryo quality.

关 键 词：输卵管切除术 控制性促排卵 体外受精-胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]