切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2019, Vol. 15 ›› Issue (01) : 81 -85. doi: 10.3877/cma.j.issn.1673-5250.2019.01.014

所属专题: 文献

论著

输卵管积水所致不孕症临床治疗分析
孙擎擎1, 曹义娟1,(), 顾娟1, 祁玉娟1, 尹倩倩1   
  1. 1. 徐州市中心医院生殖医学中心 东南大学(徐州)生殖医学研究所,江苏 221009
  • 收稿日期:2018-07-18 修回日期:2019-01-15 出版日期:2019-02-01
  • 通信作者: 曹义娟

Clinical analysis of treatment of infertility caused by hydrosalpinx

Qingqing Sun1, Yijuan Cao1,(), Juan Gu1, Yujuan Qi1, Qianqian Yin1   

  1. 1. Reproductive Medical Center, Xuzhou Central Hospital·Institute of Reproductive Medicine (Xuzhou) of Southeast University, Xuzhou 221009, Jiangsu Province, China
  • Received:2018-07-18 Revised:2019-01-15 Published:2019-02-01
  • Corresponding author: Yijuan Cao
  • About author:
    Corresponding author: Cao Yijuan, Email:
  • Supported by:
    Found program: Jiangsu Provincial Maternal and Child Health Research Project(F201677)
引用本文:

孙擎擎, 曹义娟, 顾娟, 祁玉娟, 尹倩倩. 输卵管积水所致不孕症临床治疗分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2019, 15(01): 81-85.

Qingqing Sun, Yijuan Cao, Juan Gu, Yujuan Qi, Qianqian Yin. Clinical analysis of treatment of infertility caused by hydrosalpinx[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(01): 81-85.

目的

探讨输卵管积水所致不孕症的临床治疗方法。

方法

选择2010年8月至2015年3月,东南大学(徐州)生殖医学研究所收治的144例输卵管积水所致不孕症患者为研究对象。对所有患者进行腹腔镜下输卵管造口术。对输卵管造口成功者,根据患者意愿选择是否进行体外受精-胚胎移植(IVF-ET);对输卵管造口失败者,根据患者意愿选择是否切除积水输卵管,并均进行IVF-ET治疗。所有患者临床治疗结束后电话随访3年,了解患者妊娠情况。采用t检验及χ2检验,对不同病变范围及不同治疗措施的4种情况下,不孕症患者的一般临床资料(年龄、原发性不孕患者比例)及临床妊娠率进行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求,与所有受试者签署临床研究知情同意书。

结果

①本研究144例不孕症患者中,输卵管造口术成功为95例,44例自愿接受IVF-ET治疗;输卵管造口术失败为49例,均接受IVF-ET治疗,自愿选择切除积水输卵管者为15例。②输卵管造口术成功而未接受IVF-ET治疗的51例不孕症患者中,单侧与双侧输卵管积水者的临床妊娠率比较,差异无统计学意义(16.3% vs 12.5%,χ2=0.000, P=1.000)。③输卵管造口术成功,并且接受IVF-ET治疗的44例不孕症患者中,单侧输卵管积水者临床妊娠率(72.7%),显著高于双侧者(36.4%),并且差异有统计学意义(χ2=5.867,P=0.015)。④输卵管造口术失败而接受IVF-ET治疗的49例不孕症患者中,保留与切除积水输卵管者的临床妊娠率比较,差异无统计学意义(5.9% vs 26.7%,χ2=2.474, P=0.116)。⑤接受IVF-ET治疗的93例不孕症患者中,输卵管造口术成功者的临床妊娠率(54.5%),显著高于失败者(12.2%),并且差异有统计学意义(χ2=18.983,P<0.001)。

结论

对于输卵管积水所致不孕症,尤其是单侧输卵管积水者,宜采用输卵管造口术,并接受IVF-ET治疗。是否切除积水输卵管,可能对输卵管造口术失败后接受IVF-ET治疗的输卵管积水所致不孕症患者的疗效无影响。

Objective

To investigate the clinical treatment methods for infertility caused by hydrosalpinx.

Methods

A total of 144 infertility women caused by hydrosalpinx from August 2010 to March 2015 in Institute of Reproductive Medicine (Xuzhou) of Southeast University were selected as research subjects. All the patients were performed laparoscopes salpingostomy. For patients with successful salpingostomy, the in vitro fertilization-embryo transfer (IVF-ET) were performed according to the patients′ wishes; For patients with failed salpingostomy, hydrosalpinx were resected based on the patients′ wishes, and IVF-ET treatment were carried out later. All the cases were followed up after clinic treatment finished for 3 years to get pregnant informations. Independent-samples t test and chi-square test were used to compare the general information (age, ratio of primary infertility patient) and clinical pregnancy rates in the four situations of different extent of diseas and different treatment strategies. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from all patients.

Results

①A total of 95 patients of 144 research subjects were performed with successful salpingostomy, among which 44 patients received the IVF-ET according to the patients′ wishes. All the 49 cases with failed salpingostomy were accepted the IVF-ET treatment, among whom 15 cases were performed resection of hydrosalpinx based on the patients′ wishes. ②There was no significant difference between unilateral and bilateral hydrosalpinx of the 51 patients those with successful salpingostomy and without IVF-ET treatment in clinical pregnancy rate (16.3% vs 12.5%, χ2=0.000, P=1.000). ③In the 44 cases of successful salpingostomy and with IVF-ET treatment, the clinical pregnancy rate of unilateral hydrosalpinx patients was 72.7%, which was significantly higher than that of bilateral hydrosalpinx patients′ 36.4%, and the difference was statistically significant (χ2=5.867, P=0.015). ④There was no significant difference between preserved and resected hydrosalpinx of the 49 patients those with failed salpingostomy and accepted IVF-ET treatment in clinical pregnancy rate (5.9% vs 26.7%, χ2=2.474, P=0.116). ⑤In the 93 cases with IVF-ET treatment, the clinical pregnancy rate of successful salpingostomy patients was 54.5%, which was significantly higher than that of failed salpingostomy patients′ 12.2%, and the difference was statistically significant (χ2=18.983, P<0.001).

Conclusions

For infertility caused by hydrosalpinx, especially for unilateral hydrosalpinx patients, the appropriate treatment is salpingostomy combined with IVF-ET treatment. Preserved or resected hydrosalpinx may have no influence on therapeutic effect of hydrosalpinx infertility patient that with failed salpingostomy and accepted IVF-ET treatment.

表1 输卵管造口术成功而未接受体外受精-胚胎移植治疗的51例不孕症患者中,单侧与双侧输卵管积水者的一般临床资料及临床妊娠率比较
表2 输卵管造口术成功并且接受体外受精-胚胎移植治疗的44例不孕症患者中,单侧与双侧输卵管积水者的一般临床资料及临床妊娠率比较
表3 输卵管造口术失败而接受体外受精-胚胎移植治疗的49例不孕症患者中,保留与切除积水输卵管者的一般临床资料及临床妊娠率比较
表4 接受体外受精-胚胎移植治疗的93例不孕症患者中,输卵管造口术成功与失败者的一般临床资料及临床妊娠率比较
[1]
Rantsi T, Joki-Korpela P, Hokynar K, et al. Serum antibody response to Chlamydia trachomatis TroA and HtrA in women with tubal factor infertility[J]. Eur J Clin Microbiol Infect Dis, 2018, 37(8): 1499-1502.
[2]
van Seeters JAH, Chua SJ, Mol BWJ, et al. Tubal anastomosis after previous sterilization: a systematic review[J]. Hum Reprod Update, 2017, 23(3): 358-370.
[3]
Grynnerup AG, Lindhard A, Sørensen S. Anti-Müllerian hormone levels in salpingectomized compared with nonsalpingectomized women with tubal factor infertility and women with unexplained infertility[J]. Acta Obstet Gynecol Scand, 2013, 92(11): 1297-1303.
[4]
Na ED, Cha DH, Cho JH, et al. Comparison of IVF-ET outcomes in patients with hydrosalpinx pretreated with either sclerotherapy or laparoscopic salpingectomy[J]. Clin Exp Reprod Med, 2012, 39(4): 182-186.
[5]
Ades AE, Price MJ, Kounali D, et al. Proportion of tubal factor infertility due to chlamydia: finite mixture modeling of serum antibody titers[J]. Am J Epidemiol, 2017, 185(2): 124-134.
[6]
陈冰,郑志群.输卵管因素不孕的相关治疗[J].医学综述,2011,17(7): 1036-1038.
[7]
Aleksandrovych V, Sajewicz M, Walocha JA, et al. Tubal telocytes: factor infertility reason?[J]. Folia Med Cracov, 2016, 56(2): 17-23.
[8]
Yildirim G, Ficicioglu C, Attar R, et al. Comparision of reproductive outcome of the women with hypogonadotropic hypogonadism and tubal factor infertility[J]. Clin Exp Obstet Gynecol, 2010, 37(2): 120-122.
[9]
Chanelles O, Ducarme G, Sifer C, et al. Hydrosalpinx and infertility: what about conservative surgical management?[J]. Eur J Obstet Gynecol Reprod Biol, 2011, 159(1): 122-126.
[10]
龚衍,曾玖芝,李运星,等.宫腔镜和腹腔镜联合治疗输卵管性不孕的临床分析[J/CD].中华妇幼临床医学杂志(电子版),2013,9(1): 40-43.
[11]
Galen DI, Khan N, Richter KS. Essure multicenter off-label treatment for hydrosalpinx before in vitro fertilization[J]. J Minim Invasive Gynecol, 2011, 18(3): 338-342.
[12]
Dun EC, Nezhat CH. Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology[J]. Obstet Gynecol Clin North Am, 2012, 39(4): 551-566.
[13]
李冬华,杨玲,冒韵东,等.女性不孕症相关因素分析[J/CD].中华妇幼临床医学杂志(电子版),2012,8(1): 36-38.
[14]
Okohue JE, Onuh SO, Ikimalo JI. Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility[J]. Niger J Clin Pract, 2013, 16(2): 207-210.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[10] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[11] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[12] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要