输卵管整形与输卵管切除治疗双侧输卵管重度积水不孕女性长期妊娠结局的比较  

Comparison of long-term pregnancy outcomes between neosalpingostomy and salpingectomy for infertile women with bilateral severe hydrosalpinx

作　　者：颜丽 汪央 刘小奕[1] 潘漪莲[1] 朱旻蛟 刘璟蓝 张健[1] YAN Li;WANG Yang;LIU Xiaoyi;PAN Yilian;ZHU Minjiao;LIU Jinglan;ZHANG Jian(Department of Obstetrics and Gynaecology,International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory Embryo Original Diseases,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院妇产科,上海市胚胎源性疾病重点实验室,上海200030

出　　处：《上海交通大学学报（医学版）》2023年第6期728-737,共10页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家重点研发计划(2018YFC1002102);上海市临床重点专科建设项目(shslczdzk01802)。

摘　　要：目的·比较双侧输卵管重度积水不孕女性接受输卵管整形术和输卵管切除术后的妊娠结局。方法·前瞻性纳入2005年至2012年因双侧输卵管重度积水在上海交通大学医学院附属国际和平妇幼保健院接受手术治疗的20~40岁不孕女性进行队列研究。通过术前医患共同决策制定治疗方案,并将研究对象分为输卵管整形术组与输卵管切除术组。从临床数据库中收集2组人群的临床信息,包括年龄、出生地、生育史、术前子宫输卵管造影结果、术中发现及妊娠结局。术后每年通过门诊复诊或电话问卷随访妊娠结局至2020年7月。采用意向性分析以及符合方案分析比较2组人群的妊娠结局,通过Kaplan-Meier生存分析、COX比例风险模型研究接受不同手术女性的活产结局;同时以年龄35岁为界,对研究人群进行亚组生育结局分析。主要结局指标为活产率、累积活产率及影响活产的因素;次要结局指标包括受孕方式、获得活产的时间、生化妊娠率、临床流产率、异位妊娠率。结果·共纳入113例双侧输卵管重度积水的不孕女性,其中58例接受双侧输卵管整形术,55例接受双侧输卵管切除术。双侧输卵管切除术后的累积活产率高于双侧输卵管整形术(76.36%vs 62.07%,HR=2.18,95%CI 1.37~3.45)。输卵管整形组中,34.48%(20/58)的女性通过辅助生殖治疗获得活产,27.59%(16/58)的女性通过自然受孕获得活产;且自然受孕活产结局主要发生在初次输卵管整形术后的3年内,而输卵管切除组的活产结局均通过辅助生殖治疗获得。输卵管整形组异位妊娠发生率明显高于输卵管切除组(20.69%vs 1.82%,P<0.001),2组生化妊娠率、临床流产率差异无统计学意义。进一步年龄分层分析显示,35岁以下双侧输卵管重度积水女性接受输卵管整形术(51例)者的累积活产率显著低于输卵管切除术(48例)后(HR=2.25,95%CI 1.39~3.66);35岁及以上女性2组(各Objective·To compare the pregnancy outcomes of infertile women with bilateral severe hydrosalpinx receiving neosalpingostomy or salpingectomy.Methods·The single-center prospective cohort study from 2005 to 2012 focused on pregnancy outcomes of infertile women aged 20‒40 years,with bilateral severe hydrosalpinx,undergoing bilateral neosalpingostomy or salpingectomy in International Peace Maternal and Child Health Hospital,Shanghai Jiao Tong University School of Medicine.The choice for treatment was based on a shared decision approach,and the participants were divided into the neosalpingostomy group and salpingectomy group.After registration of baseline characteristics,including age,birth place,reproductive history,preoperative hysterosalpingography results,surgical findings,and pregnancy outcomes,women were followed up on an annual basis until July 2020 for the occurrence of live birth by outpatient follow-up or telephone questionnaire.Intention-to-treat analysis and per-protocol analysis were applied to compare the pregnancy outcomes.Kaplan-Meier analysis and COX proportional hazard model were used to analyze the reproductive outcomes.In addition,subgroup analysis was performed based on age stratification.The main outcome measures were live birth rate,cumulative live birth rate,and factors affecting live birth.Secondary outcome measures included the mode of conception,time to live birth,biochemical pregnancy rate,clinical miscarriage rate,and ectopic pregnancy rate.Results·A total of 113 women were included in the analysis,58 women underwent bilateral neosalpingostomy,and 55 women underwent bilateral salpingectomy.The study demonstrated that in infertile women with bilateral severe hydrosalpinx,bilateral salpingectomy achieved higher cumulative live birth rate than bilateral neosalpingostomy(76.36%vs 62.07,HR=2.18,95%CI 1.37‒3.45).In the neosalpingostomy group,34.48%(20/58)live births were obtained after in vitro fertilization treatment,and 27.59%(16/58)live births were obtained through spontaneous concept

关 键 词：输卵管积水 输卵管不孕 输卵管整形术 输卵管切除术 活产率 

分 类 号：R713.5[医药卫生—妇产科学]