输卵管因素不孕患者在体外受精-胚胎移植前行腹腔镜手术的获益程度  

Degree of benefit from laparoscopic surgery before in vitro fertilization and embryo transfer in infertile patients with tubal obstruction

作　　者：王媛媛 刘文娟 黄莉[1] 阮建兴[1] 翁慧男[1] 刘风华[1] WANG Yuanyuan;LIU Wenjuan;HUANG Li;RUAN Jianxing;WENG Huinan;LIU Fenghua(Reproductive Medicine Center,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院生殖健康与不孕症科,广州511400

出　　处：《实用医学杂志》2023年第4期442-446,共5页The Journal of Practical Medicine

基　　金：国家重点研发计划课题(编号:2018YFC1002604);广东省卫济医学发展基金会临床研究项目(编号:K-202104-2)。

摘　　要：目的 探讨轻度输卵管远端梗阻不孕患者在体外受精-胚胎移植(IVF-ET)前行腹腔镜手术的获益程度。方法 回顾性分析2013年1月至2018年6月,在广东省妇幼保健院生殖健康与不孕症科就诊的228例输卵管因素不孕症患者。选择首先进行腹腔镜治疗患者148例,随访术后2年内自然妊娠结局;腹腔镜术后6个月未自然妊娠转IVF-ET者纳入为手术组(n=84),选择同期未经腹腔镜手术轻度输卵管远端梗阻不孕患者为非手术组(n=80),对比两组患者第一次新鲜胚胎移植周期的妊娠结局,评估IVF-ET前行腹腔镜手术的获益程度。结果 148例患者腹腔镜术后2年内的自然临床妊娠率为29.7%,约50%的妊娠发生在术后6个月内。IVF-ET结局中手术组早期流产率低于非手术组,差异有统计学意义(P <0.05);临床妊娠率、异位妊娠率、活产率差异无统计学意义(P> 0.05)。结论 轻度输卵管远端梗阻患者腹腔镜术后2年内可获得约30%的自然妊娠率,如术后6个月未自然妊娠者建议行IVF-ET;轻度输卵管远端梗阻患者IVF-ET前行腹腔镜手术治疗,可能降低早期流产率。Objective To explore the degree of benefit from laparoscopic surgery before in vitro fertilization and embryo transfer(IVF-ET)in infertile patients with mild distal tubal obstruction.Methods Retrospective analysis of clinical data,from January 2013 to June 2018,228 patients with tubal infertility who were treated in the Reproductive Medicine Center of Guangdong Women and Children Hospital,underwent Hysterosal-pingo-contrast sonography or hysterosalpingography showed unilateral or bilateral distal fallopian tube occlusion or smooth obstruction.148 patients chose laparoscopic surgery at first,followed up the natural pregnancy outcome within 2 years after the operation.Patients who did not have pregnancy at 6 months after laparoscopic surgery transferred to IVF-ET as operation group.Those who choose to undergo IVF-ET directly as non-operation group.Compared the outcome of first IVF-ET cycle between two groups,evaluated the degree of benefit from laparoscopic surgery before IVF-ET.Results The natural clinical pregnancy rate in 148 patients within 2 years after surgery was 29.73%,about 50%of pregnancies occurred in 6 mouths after surgery.The early abortion rate in operationg group was lower than that in non-operation group,and the difference was statistically significant(P<0.05);there was no statistically significant difference in clinical pregnancy rate,ectopic pregnancy rate,and live birth rate(P<0.05).Conclusion Natural pregnancy rate of 148 patients with mild distal fallopian tube occlusion within 2 years after laparoscopic surgery was about 30%,and about 50% of natural pregnancy occured within 6 months after laparoscopic surgery.Patients who did not have pregnancy at 6 months after laparoscopic surgery,transferred to IVF-ET,compared with patients who choose IVF-ET directly,clinical pregnancy rate was similar,early abortion rate was more lower.

关 键 词：不孕症 输卵管梗阻 远端梗阻 腹腔镜检查 体外受精-胚胎移植 临床妊娠率 早期流产率 

分 类 号：R713.7[医药卫生—妇产科学]