CAJ | 학술논문

【目的】探讨输卵管积水不同处理方式对体外受精-胚胎移植（IVF-ET ）结局的影响。【方法】收集因输卵管因素（102例输卵管积水）行IVF-ET患者154例，根据IVF-ET 术前对输卵管积水不同处理方式将患者分为五组：A 组积水未处理16例；B组输卵管积水抽吸35例；C组腹腔镜下输卵管积水切除15例；D组腹腔镜下输卵管积水近端结扎远端造口36例；E组（对照组）输卵管梗阻，无积水52例，比较各组促性腺激素（Gn）用量、促排天数、人绒毛膜促性腺激素（HCG）日雌二醇（E2）水平、取卵数、移植胚胎数、受精率、妊娠率、流产率、异位妊娠率等指标。【结果】各组的Gn用量、促排天数、hCG日E2水平、移植胚胎数、受精率、异位妊娠率间差异无统计学意义（P ＞0．05）；获卵数C组最少，与其他组相比有统计学意义（P ＜0．05）。临床妊娠率A组最低（25％），D组最高（56％），A组与C、D、E组比较有统计学差异（ P ＜0．05），与B组比较无统计学差异；流产率A 组最高（67％），D组最低（10％），A组与C、D、E组比较有统计学差异（ P ＜0．05），与B组比较无统计学差异。【结论】输卵管积水降低胚胎种植率和临床妊娠率，增加流产率，在IVF-ET 治疗前处理输卵管积水有助于提高胚胎种植率，改善妊娠结局。采用腹腔镜下输卵管近端结扎远端造口术是治疗输卵管积水比较适宜的方式。
【목적】탐토수란관적수불동처리방식대체외수정-배태이식（IVF-ET ）결국적영향。【방법】수집인수란관인소（102례수란관적수）행IVF-ET환자154례，근거IVF-ET 술전대수란관적수불동처리방식장환자분위오조：A 조적수미처리16례；B조수란관적수추흡35례；C조복강경하수란관적수절제15례；D조복강경하수란관적수근단결찰원단조구36례；E조（대조조）수란관경조，무적수52례，비교각조촉성선격소（Gn）용량、촉배천수、인융모막촉성선격소（HCG）일자이순（E2）수평、취란수、이식배태수、수정솔、임신솔、유산솔、이위임신솔등지표。【결과】각조적Gn용량、촉배천수、hCG일E2수평、이식배태수、수정솔、이위임신솔간차이무통계학의의（P ＞0．05）；획란수C조최소，여기타조상비유통계학의의（P ＜0．05）。림상임신솔A조최저（25％），D조최고（56％），A조여C、D、E조비교유통계학차이（ P ＜0．05），여B조비교무통계학차이；유산솔A 조최고（67％），D조최저（10％），A조여C、D、E조비교유통계학차이（ P ＜0．05），여B조비교무통계학차이。【결론】수란관적수강저배태충식솔화림상임신솔，증가유산솔，재IVF-ET 치료전처리수란관적수유조우제고배태충식솔，개선임신결국。채용복강경하수란관근단결찰원단조구술시치료수란관적수비교괄의적방식。
[Objective]To explore the effect of different treatments for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer(IVF-ET) .[Methods] Totally 154 patients with infertility derived from tubal causes(102 patients with a history of hydrosalpinx ) undergoing IVF-ET were collected .According to dif-ferent treatments for hydrosalpinx before IVF-ET ,all patients were divided into group A (without treatment for hydrosalpinx ,n=16) ,group B(hydrosalpinx aspiration ,n=35) ,group C(laparoscopy resection of hydro-salpinx ,n=15) ,group D(proximal tubal ligation and distal tubal salpingostomy by laparoscopy ,n =36) and group E(control group of concurrent tubal obstruction without hydrosalpinx ,n=52 ) .The dose of gonadotro-pin(Gn) ,the duration of stimulation ,estradiol(E2 ) level on HCG day ,the number of retrieved oocytes and the transferred embryo ,the fertilization rate ,pregnancy rate ,abortion rate and ectopic pregnancy rate were compared among groups .[Results] There was no significant difference in Gn dosage ,the duration of stimula-tion ,E2 level on HCG day ,the number of the transferred embryo ,the fertilization rate and ectopic pregnancy rate among groups( P >0 .05) .The number of retrieved oocytes in group C was the lowest ,and there was significant difference between group C and other groups ( P <0 .05) .Clinical pregnancy rate of group A was lowest(25% ) and that of group D was highest (56% ) ,and there was significant difference between group A and group C ,D and E( P<0 .05) ,but there was no significant difference between group A and group B .The abortion rate of group A was highest(67% ) and that of group D was lowest(10% ) ,and there was significant difference between group A and group C ,D and E( P<0 .05) ,but there was no significant difference between group A and group B .[Conclusion] Hydrosalpinx may decrease the implantation rate of embryos and increase the abortion rate .Treatments for hydrosalpinx before IVF-ET are helpful for increasing embryo implantation rate and improving the pregnancy outcome .Proximal tubal ligation and distal tubal salpingostomy by laparos-copy can be considered for the suitable treatment of hydrosalpinx .