腹腔镜探查术治疗反复种植失败患者价值分析  

Value analysis of laparoscopy in the treatment of recurrent implantation failure.

作　　者：郑兴邦[1] 蔡贺[1] 于晓明[1] 韩红敬[1] 关菁[1] ZHENG Xing-bang;CAI He;YU Xiao-ming;HAN Hong-jing;GUAN Jing(Peking University People's Hospital Reproductive Medicine Center,Beijing 100044,China)

机构地区：[1]北京大学人民医院生殖医学中心,北京100044

出　　处：《中国实用妇科与产科杂志》2022年第3期363-365,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市卫生与健康科技成果和适宜技术推广项目(2018-TG-16)。

摘　　要：目的探讨腹腔镜探查术能否改善反复种植失败患者的妊娠结局。方法回顾性分析2010年1月至2019年1月北京大学人民医院收治的因反复种植失败行腹腔镜探查术治疗的患者共72例。术中对于并存的盆腔疾病进行相应处理,如输卵管积水予以伞端造口术或者输卵管切除术;子宫内膜异位症予以病灶电灼术;盆腔粘连予以盆腔粘连松解术。术后根据患者意愿尝试自然妊娠或者再次体外受精(IVF)治疗。术后随访24个月,统计妊娠率、流产率及活产率。结果72例患者中,66例(91.7%)术中发现盆腔异常,子宫内膜异位症最为常见,约占61.1%(44/72);17例(23.6%)合并输卵管积水;4例(5.6%)合并单纯盆腔粘连。术后总妊娠率为63.9%(46/72),活产率为58.3%(42/72)。输卵管积水患者妊娠率为82.4%(14/17),活产率为70.6%(12/17);子宫内膜异位症患者术后妊娠率为56.8%(25/44),活产率为52.3%(23/44);单纯盆腔粘连患者术后妊娠率和活产率均为75%(3/4)。结论对于反复种植失败合并盆腔病变高危因素患者可尝试腹腔镜探查术,发现并处理影响妊娠的盆腔因素;腹腔镜探查术可改善患者妊娠结局,并使之有自然妊娠的机会。Objective To investigate whether laparoscopy can improve pregnancy outcomes in patients with recurrent implantation failure(RIF).Methods A retrospective analysis was made in 72 patients who underwent laparoscopy due to RIF from January 2010 to January 2019.All the coexisting pelvic diseases were dealt with during the surgery,including salpigostomy or salpingectomy for hydrosalpinx,electrocautery for endometriosis and adhesiolysis for pelvic adhesions.Natural pregnancy or IVF was attempted after surgery according to the patient's wishes.The pregnancy rate,natural abortion rate and live birth rate were analysed after 24 months of follow-up.Results Among the 72 patients,66(91.7%)had abnormal pelvic pathoglogy.Endometriosis was the most common,accounting for 61.1%(44/72);There were 17 cases(23.6%)of hydrosalpinx,and 4 cases(5.6%)of simple pelvic adhesion.The pregnancy rate was 63.9%(46/72)and the live birth rate was 58.3%(42/72).The pregnancy rate of patients with hydrosalpinx was 82.4%(14/17)and the live birth rate was 70.6%(12/17).Postoperative pregnancy rate of patients with endometriosis was 56.8%(25/44)and live birth rate was 52.3%(23/44).Pregnancy rate and live birth rate in patients with pelvic adhesions was 75%(3/4).Conclusion Laparoscopy can be given to RIF patients with high risk of pelvic pathoglogy to deal with the pelvic factors that affect pregnancy.Laparoscopy can improve pregnancy outcomes and patients can have the chance of natural pregnancy.

关 键 词：反复种植失败 腹腔镜 输卵管积水 子宫内膜异位症 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]