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目的:探讨体外受精-胚胎移植(IVF-ET)中不同的输卵管手术方式对治疗结局的影响。方法:回顾性分析长方案超促排卵IVF周期378例输卵管因素不孕患者:双侧输卵管切除58例(A组);双侧输卵管造口45例(B组);双侧输卵管近端结扎+远端造口37例(C组);单侧输卵管整形42例(D组);单侧输卵管切除45例(E组);随机选取单纯双侧输卵管梗阻无积水患者151例作为对照组(F组);比较患者的一般情况、卵巢对促排卵的反应性和临床治疗结局。结果:①基础窦卵泡(bAFC)数、Gn使用总量、Gn用药时间、hCG注射日卵泡数目、获卵数及冷冻胚胎数,A组较其他手术组及对照组差异均有统计学意义(P<0.05);其他手术组与对照组比较,差异无统计学意义(P>0.05)。各组间受精率、优质胚胎率和移植胚胎数均无统计学差异(P>0.05)。B组妊娠率和种植率显著低于其他各组,而异位妊娠率和流产率显著高于其他各组(P<0.05)。②E组患侧(手术侧)hCG注射日卵巢体积(OVVOL)、卵泡数(直径≥15 mm)和获卵数明显少于健侧卵巢(P<0.05),而D组患侧与健侧上述指标差异无统计学意义(P>0.05)。结论:双侧输卵管切除术增大了促排卵Gn用量和使用天数,减少了获卵数;但不影响受精率、优质胚胎率及着床率,因而不影响IVF-ET单次临床妊娠率。单侧手术由于健侧输卵管的代偿作用对IVF治疗无明显影响。造口术再次发生输卵管积水风险升高,种植率、妊娠率下降,异位妊娠率和流产率升高。
OBJECTIVE: To investigate the effects of different tubal surgical procedures on outcome in IVF-ET. Methods: A total of 378 cases of tubal infertility were enrolled in this study. A total of 378 cases of tubal infertility were enrolled in this study. A total of 58 cases of bilateral tubal resection (group A), 45 cases of bilateral tubal stoma (group B) 37 cases of distal ostomy (group C), 42 cases of unilateral tubal plastic surgery (group D), 45 cases of unilateral tubal resection (group E), 151 cases of patients with simple bilateral tubal obstruction without water were randomly selected as the control group F group); compare the general situation of patients, ovarian response to ovulation induction and clinical treatment outcome. Results: (1) The number of basal antral follicles (bAFC), total amount of Gn, Gn treatment time, the number of follicles on the day of hCG injection, the number of oocytes retrieved and the number of frozen embryos were significantly different in group A compared with other surgical groups and control group P <0.05). There was no significant difference between the other operation groups and the control group (P> 0.05). There was no significant difference in fertilization rate, high-quality embryo rate and the number of embryos transferred between groups (P> 0.05). The pregnancy rate and implantation rate in group B were significantly lower than those in other groups, while the rates of ectopic pregnancy and abortion were significantly higher than those in other groups (P <0.05). ② The volume of ovary (OVVOL), the number of follicles (diameter ≥15 mm) and the number of oocytes retrieved on the iC side (group C) on the affected side of operation group E were significantly less than those on the healthy side (P <0.05) No significant difference in indicators (P> 0.05). CONCLUSIONS: Bilateral salpingo-tubal resection increases the amount of Gn for ovulation induction and the number of days it is used, and decreases the number of oocytes retrieved. However, it does not affect fertilization rate, excellent embryo rate and implantation rate, and therefore does not affect single clinical pregnancy rate of IVF-ET. Unilateral surgery due to contralateral fallopian tube compensatory effect on IVF treatment had no significant effect. Ostomy recurrence of tubal water increased risk, implantation rate, pregnancy rate decreased, ectopic pregnancy rate and abortion rate increased.