输卵管积水的不同处理及附件手术对体外受精-胚胎移植结局的影响

目的探讨输卵管积水的不同处理、输卵管手术及卵巢手术对体外受精-胚胎移植（IVF—ET）结局的影响。方法选择2003年10月至2007年12月我中心常规IVF-ET助孕的1，452个周期的临床资料，按不同处理分为输卵管切除组与输卵管造口组；卵巢巧克力囊肿（巧囊）与非巧囊囊肿剔除组；输卵管积水近端结扎远端造口组、输卵管积水切除组、积水穿刺抽吸组与积水未治疗组，以单纯输卵管阻塞为对照组，比较各组超排卵中卵巢反应及妊娠结局。结果与对照组相比，输卵管切除组、造口组卵巢反应及妊娠结局无明显差异，单侧输卵管手术不影响术侧卵巢反应（P〉0．05）；卵巢囊肿剔除术后Gn用量显著增加，获卵数显著减少，单侧卵巢手术影响术侧卵巢功能（P〈0．05）。与输卵管积水未治疗组相比，积水手术治疗后临床妊娠率、胚胎种植率显著增加（P〈0．05），积水穿刺抽吸组临床妊娠率显著升高（P〉0．05）。结论输卵管手术不影响卵巢功能；卵巢囊肿剔除术后卵巢储备能力降低；输卵管积水对IVF-ET有负面影响，适当处理可改善妊娠结局，与积水穿刺抽吸术比较，IVF-ET前积水输卵管切除疗效更佳。

Effects of different treatments for hydrosalpinx and adnexal surgery on in vitro fertilization-embryo transfer outcome

Objective：To explore the effects of treatments for hydrosalpinx and adnexal surgery on the outcome of in vitro fertilization-embryo transfer （IVF-ET）. Methods： A total of 1452 IVF-ET cycles performed in our center from October 2003 to December 2007 were studied. The ovarian response to superovulation and the outcome of IVF-ET were evaluated in the following groups： salpingectomy, salpingostomy; ovarian cystectomy of endometriomas or nonendometriomas; hydrosalpinges treated with proximal tubal ligation and distal tubal salpingostomy, salpingectomy, aspiration of hydrosalpinx during oocyte collection, and without previous intervention. Patients with obstructive fallopian tube served as the control. Results： Compared with the control group, salpingectomy and salpingostomy did not significantly impair ovarian response and the outcome of IVF-ET. The operation on unilateral fallopian tube did no harm to ipsilateral ovarian response （P〉0.05）. The patients with ovarian cystectomy of endometriomas or nonendometriomas required more ampoules of gonadotropin for ovarian stimulation and had fewer oocytes retrieved. It was obvious that the operation on unilateral ovary had a negative effect on ipsilateral ovarian response （P〈0.05）. The surgical intervention for hydrosalpinges demonstrated notably increased embryo implantation and clinical pregnancy rates （P〈0.05）. But no statistically significant improvement was achieved through hydrosalpinx aspiration during oocyte collection （P〉0.05）. Conclusions. Salpingectomy and salpingostomy do not affect ovarian function. Ovarian cystectomy may damage ovarian reserve. Hydrosalpinx adversely affects IVF-ET outcome, and appropriate procedure should be adopted in order to improve the outcome. Compared with hydrosalpinx aspiration during ooeyte collection, the pretreatment for hydrosalpinx before IVF-ET seems better.