【作者】 陈冰；

【导师】 郑志群；

【作者基本信息】 福建医科大学 ， 妇产科学， 2011， 硕士

【摘要】 【目的】分析比较严重输卵管疾病及输卵管积水所致的输卵管不孕患者IVF-ET前是否输卵管切除在获得妊娠上的差异。【方法】全面检索相关中英文数据库,系统搜索输卵管不孕严重输卵管疾病或输卵管积水患者在IVF-ET前是否行输卵管切除方面的前瞻性及回顾性研究文献,提取数据资料,应用系统评价的专用处理软件Revman5.0进行整合分析。【结果】共有7篇文献被纳入。对于该“输卵管切除对于IVF-ET结果影响”的系统评价,目的是比较切除组(治疗组)和保留组(对照组)在获得妊娠上的差别。总共1998-2005年之间五个研究入选,切除组总共183例,保留组总共117例。结果表明图1在比较两者的临床妊娠情况OR=1.56(95%CI,1.13-2.15)>1,菱形完全位于垂直线的右侧,得出切除组更有效的结论;图2比较两者的持续妊娠情况OR=1.68(95%CI,2.20-2.36)>1,菱形完全位于垂直线的右侧,也得出切除组更有效的结论。图3把其中三个文献的异位妊娠发生情况进行比较,差异无统计学意义,菱形与垂直线相交表明差异无统计学意义,但由于这个分支的META分析病例数少,结果缺乏说服力。图4把其中三个文献的胚胎种植成功率发生情况进行比较,OR=1.5(95%CI,1.03-2.2)>1差异有统计学意义,菱形位于垂直线右侧支持差异有统计学意义,得出切除组更有效的结论。表7把国内两篇文献进行的输卵管因素不孕未合并积水患者输卵管切除组与非切除组的获卵率的比较P<0.5(表7):得出输卵管切除会引起卵巢的低反应性,减低获卵率。【结论】输卵管不孕患者根据其输卵管病变的情况选择IVF-ET,IVF-ET前是否选择进行手术与患者的自身情况相关,该分析得出:输卵管积水的输卵管不孕患者在IVF-ET前行输卵管的手术将有利于提高IVF-ET的成功率,但输卵管切除引起的卵巢低反应性可能降低IVF-ET成功率,故应慎行切除术。轻度的可行成形术的则选择各种成形术,无法行成形术的输卵管有研究示IVF-ET前行输卵管离断术可提高IVF-ET妊娠率,但这点有待更多RCT的文章来论证。更多还原

【Abstract】 【objective】:To compare the pregnancy rates differences of patients have salpinges ,severe tubal dieases performed salpingectomy or not before IVF-ET in salpingian infertility curing.【method】: A systemic-through search of the literatures were performed of both prospective and retrospective studies , taking up the data for meta-analysis fowlled.【result】: 1. 5studies were included in the meta-analysis.2. This system evaluation is about whether infertility patients by tubal factors before IVF-ET must have salapingectomy or not, aims to compare the percent of clinical pregnancy and the ongoning pregnancy in this two groups.It takes five studies in this article,the nmbers of salpingectomy patients is 183,and the other group is 117.The result of comparation of the clinical pregnancy is (that) OR=1.56(95%CI,1.13-2.15)>1,the rhombus of the gram 1 is at the RT of the vertical line, that means the curation groups take better effectiveness. The result of comparation of the ongoing pregnancy is (that) OR=1.68(95%CI,2.20-2.36)>1,the rhombus of the gram 2 is at the RT of the vertical line,that means the curation groups take better effectiveness too.The result of comparation of the ectopic pregnancy is (that) OR=0.84(95%CI,0.4-1.75),the rhombus of the gram 3 is get across of the vertical line,that means no difference in two groups. The result of comparation of the embry transfer is (that) OR=1.5(95%CI,1.03-2.2)>1 the rhombus of gram 4 at the RT of the vertical line,that means the curation groups take better effectiveness too. From table7 we can see :Tubal factor infertility without salpingx if choice salpingectomy will influences ovarian function.Th e reason may be that operation impaired ovarian blood flow.Compare the retrieved oocytes between the salpingectomy group and the remaining group ,the p is <0.5: Salpingectomy will influences ovarian function and make the lower percent of the retrieved oocytes.【conclusion】: The infertility patients by tubal factors make the choice to IVF-ET,before IVF-ET taking some operation or not must detimine by the Patients’condition.In this meta-analysis we can find: The presence of hydrosalpinges in women considering IVF treatment is an indication for surgical treatment,it must be careful to do salpingectomy for that may cause lower response to stimulus of the ovarian.If the tubal have chance to choice salpingplasty then do that.If the disease is serious ,choice the surgery to cut the tubal but keep the blood vessel may be good ,but that need more RCT articles to proof.更多还原