妇科手术过程中取卵行生育力保存的初步研究  

Preliminary study of fertility preservation by oocytes retrieval during gynecological operation

作　　者：彭瑞瑞 董冉 李淼 张帅 韩婷 黄玉真 李梅 Peng Ruirui;Dong Ran;Li Miao;Zhang Shuai;Han Ting;Huang Yuzhen;Li Mei(Center for Reproductive Medicine,Shandong University(Affiliated Reproductive Hospital of Shandong University)/Key Laboratory of Reproductive Endocrinology of Ministry of Education,Shandong University/Shandong Key Laboratory of Reproductive Medicine/Shandong Provincial Clinical Research Center for Reproductive Health/Shandong Technology Innovation Center for Reproductive Health/National Research Center for Assisted Reproductive Technology and Reproductive Genetics,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学生殖医学研究中心(山东大学附属生殖医院)、生殖内分泌教育部重点实验室(山东大学)、山东省生殖医学重点实验室、山东省生殖健康临床医学研究中心、山东省生殖健康技术创新中心、国家辅助生殖与优生工程技术研究中心,济南250012

出　　处：《中华生殖与避孕杂志》2023年第2期145-149,共5页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发计划(2022YFC2704404,2022YFC2703000);国家自然科学基金(82171842)。

摘　　要：目的探讨妇科手术过程中取卵行生育力保存的方法,为不宜经阴道取卵行生育力保存的患者提供实验依据。方法研究对象为2020年4月至6月期间于山东大学附属生殖医院拟行腹腔镜手术的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者和妇科手术中拟行生育力保存的肿瘤患者。本研究为回顾性研究,经患者知情同意后对23例拟行输卵管手术的PCOS不孕症患者进行卵巢表面小卵泡穿刺取卵,获卵后送入辅助生殖实验室进行体外培养,获得优质胚胎冷冻保存。对拟行生育力保存的6例肿瘤患者妇科手术同时卵巢表面卵泡穿刺进行卵子体外培养。根据获卵、成熟、受精及胚胎培养等指标评价妇科手术过程中取卵的可行性。结果对于PCOS患者,腹腔镜引导下卵巢表面卵泡穿刺的每周期获卵率为52.17%(12/23),获卵患者的获卵数为(2.00±1.48)枚,其中可培养卵数为(1.50±1.00)枚,卵子成熟率为22.22%(4/18),受精2枚,卵裂1枚。拟行生育力保存的肿瘤患者妇科手术每周期获卵率为100.00%(6/6),获卵数为(3.00±1.27)枚,卵子成熟率为38.46%(5/13),受精3枚,1枚发育至囊胚,3例获得可冷冻卵子或胚胎。结论对于不适合经阴道取卵行生育力保存的患者,妇科手术过程中取卵可以获得可利用卵子。Objective To find a method for fertility preservation through oocytes retrieval during gynecological operation and provide an experimental basis for patients who are not suitable for fertility preservation by transvaginal oocyte retrieval.Methods The objects of the study were patients with polycystic ovary syndrome(PCOS)who underwent laparoscopic surgery in the Affiliated Reproductive Hospital of Shandong University from April to June 2020 and patients with tumors who underwent fertility preservation during gynecological surgery.This was a retrospective study.Totally 23 patients with PCOS infertility who were to undergo laparoscopy surgery underwent ovarian surface follicle puncture for oocyte retrieval,and the oocytes were obtained and sent to the assisted reproduction laboratory for in vitro culture,and mature oocytes were inseminated by intracytoplasmic sperm injection(ICSI),and high-quality embryos were obtained for cryopreservation.Gynecological surgery and ovarian surface follicle puncture were performed for oocytes retrieval in tumor patients(n=6)with fertility preservation.The feasibility of simultaneous gynecological surgery with oocytes retrieved was evaluated according to the indexes of the number of oocytes retrieval,maturation,fertilization and embryo culture.Results In PCOS patients,oocytes retrieved rate was 52.17%(12/23)per cycle.The number of oocytes retrieved was 2.00±1.48,among which the number of culturable oocytes was 1.50±1.00.The oocyte maturation rate was 22.22%(4/18).Two oocytes got fertilization and one zygote got cleavage.In contrast,the fertility-preserving oncology patients undergoing gynecologic surgery had a 100.00%(6/6)oocytes retrieved rate per cycle,with 3.00±1.27 oocytes retrieved.Oocyte maturation rate was 38.46%(5/13).Three oocytes got fertilization and one blastocyst formed.Three patients got oocytes or embryos cryopreservation.Conclusion For patients who are not suitable for transvaginal oocyte retrieval for fertility preservation,follicle puncture during the gynecologic

关 键 词：腹腔镜手术 肿瘤 妇科手术 卵泡穿刺 卵子体外成熟 生育力保存 

分 类 号：R737.3[医药卫生—肿瘤]