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目的:探讨IVF-ET中不同的输卵管手术方式对控制性超排卵(COH)过程中患者卵巢反应性的影响。方法:回顾性分析长方案超排卵IVF周期临床资料,选择397例因输卵管因素不孕患者,其中手术组176例,非手术组221例;手术组患者均因输卵管妊娠或输卵管阻塞、粘连或积水行单侧或双侧输卵管切除或输卵管修复整形手术,其中单侧输卵管切除组70例(A组),双侧输卵管切除组46例(B组),单侧输卵管整形组27例(C组),双侧输卵管整形组33例(D组);非手术组均未为双侧输卵管阻塞无积水患者,作为对照组(E组)。比较各组的临床资料、卵巢对促排卵的反应性和妊娠结局。结果:B组基础FSH值显著高于E组(P<0.05),卵泡数(直径≥15mm)、获卵数显著低于E组(P<0.05)。A组术侧卵巢卵泡数(直径≥15mm)和获卵数明显少于健侧卵巢(P<0.05)。但输卵管手术不影响IVF-ET,各组的的妊娠率和种植率无统计学差异。结论:输卵管切除降低了卵巢超排卵时的反应性,手术可能影响卵巢的血供进而影响卵巢对COH的反应。
OBJECTIVE: To investigate the effects of different tubal surgical procedures on ovarian response in patients with controlled hyperstimulation (COH) in IVF-ET. Methods: A retrospective analysis of long-term clinical data of IVF cycle of super-ovulation, select 397 cases of infertility due to tubal factors, including 176 cases of surgical group, 221 cases of non-surgical group; surgical patients were tubal pregnancy or tubal obstruction, adhesions or plot Unilateral or bilateral tubal resection or tubal repair and plastic surgery were performed in 70 cases (group A), 46 cases (group B) and 27 cases (group C) with unilateral tubal plastic surgery ), Bilateral salpingoplasty group 33 cases (group D); non-operation group were not bilateral tubal occlusion without water, as a control group (group E). Compare the clinical data of each group, ovarian response to ovulation induction and pregnancy outcome. Results: The basal FSH value of group B was significantly higher than that of group E (P <0.05). The number of follicles (diameter ≥15mm) and the number of oocytes retrieved were significantly lower than those of group E (P <0.05). The number of ovarian follicles (diameter ≥15mm) and number of oocytes retrieved in group A were significantly less than those in contralateral ovary (P <0.05). However, tubal surgery did not affect IVF-ET, pregnancy rate and implantation rate of each group was not statistically different. CONCLUSIONS: Tubal resection reduces the reactivity of ovarian superovulation. Surgery may affect ovarian blood supply and affect ovarian response to COH.