CAJ | 학술논문

任何不孕夫妇都希望通过寻求一切合理的治疗手段来实现妊娠。其中20%以上夫妇是由于输卵管因素导致的不孕，这部分患者面临的治疗选择有：微创手术和体外受精（IVF）。大多数情况下，在这一决策过程中必须切实有效地比较这两种方法的疗效、不良反应及费用。目前证据显示，微创手术对于输卵管疏松粘连、轻微的远端输卵管梗阻、近端输卵管梗阻及输卵管妊娠的治疗更加有效。一个成功的输卵管修复手术不仅可以使不孕夫妇避免进一步的治疗，而且也获得了能够自然妊娠的心理优势。在IVF治疗前或过程中，根据输卵管病变进行个体化的微创手术治疗，可以提高IVF疗效、宫内妊娠率及活产率。 IVF周期中异位妊娠的发病率高于自然人群，微创手术治疗异位妊娠不但创伤小，而且可以尽量减小对后续IVF疗效的影响。目前认为将微创手术和IVF综合运用，才能使不孕患者获得最佳的生育结局。
임하불잉부부도희망통과심구일절합리적치료수단래실현임신。기중20%이상부부시유우수란관인소도치적불잉，저부분환자면림적치료선택유：미창수술화체외수정（IVF）。대다수정황하，재저일결책과정중필수절실유효지비교저량충방법적료효、불량반응급비용。목전증거현시，미창수술대우수란관소송점련、경미적원단수란관경조、근단수란관경조급수란관임신적치료경가유효。일개성공적수란관수복수술불부가이사불잉부부피면진일보적치료，이차야획득료능구자연임신적심리우세。재IVF치료전혹과정중，근거수란관병변진행개체화적미창수술치료，가이제고IVF료효、궁내임신솔급활산솔。 IVF주기중이위임신적발병솔고우자연인군，미창수술치료이위임신불단창상소，이차가이진량감소대후속IVF료효적영향。목전인위장미창수술화IVF종합운용，재능사불잉환자획득최가적생육결국。
The goal of infertile couples are to achieve pregnancy via exploring all reasonable attempts. The infertile couples who are due to tubal disease, account for more than 20%of all infertile couples, have two options to achieve this goal:minimally invasive tubal surgery and in vitro fertilization (IVF). In most cases, the decision-making process requires detailed and effective discussion on the curative effect, side effect and cost of the procedures. The available evidence shows that tubal surgery can be more effective for cases of tubal adhesions, mild distal tubal occlusion, proximal obstruction and ectopic pregnancy. A successful tubal reconstructive surgery can not only make infertile couples to avoid further treatment, but also obtain the psychological advantage to conceive naturally. Before or during IVF treatment, individualized minimally invasive surgery treatment which according to tubal pathological changes, can improve the curative effect of IVF, intrauterine pregnancy rate and live birth rates. The incidence of ectopic pregnancy (EP) in IVF cycle is higher than that of natural population, minimally invasive surgery treatment for EP not only less trauma, but also can reduce the impact on subsequent IVF as far as possible. Now the most pragmatic viewpoint is to consider reproductive surgery and in vitro fertilization as complementary options that are directed towards increasing the overall probability of achieving a pregnancy in the most efficient manner.