输卵管介入栓塞术在预防输卵管残端妊娠中的应用
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摘要
目的探讨输卵管残端妊娠的临床特点,以及评价输卵管介入栓塞术在预防输卵管残端妊娠中的应用价值。方法体外受精-胚胎移植(IVF-ET)术前行输卵管积水预处理的患者中,有35例为输卵管残端患者,其中单侧输卵管术后28例,双侧输卵管术后7例。输卵管残端长度10~45 mm,平均25 mm。所有病例均用微弹簧圈介入栓塞输卵管,术后行IVF-ET并观察妊娠率及异位妊娠率。结果 35例患者均成功栓塞双侧输卵管,术后IVF-ET妊娠率48.5%(17/35),无一例发生输卵管残端妊娠。结论输卵管介入栓塞术应用于栓塞输卵管残端,能有效避免输卵管残端妊娠。
Objective To investigate the clinical characteristics of tubal stump pregnancy, and to assess the value of interventional embolization in preventing tubal stump pregnancy. Methods Among the patients who were planned to receive preoperative treatment of hydrosalpinx before the performance of in vitro fertilization-embryo transfer(IVF-ET) at authors' hospital, 35 patients had stump of fallopian tube. Of the35 patients, previous surgery of unilateral fallopian tube was present in 28 and previous surgery of bilateral fallopian tubes in 7. The length of tubal stump ranged from 10 mm to 45 mm, with a mean of 25 mm.Interventional embolization with micro-coils was carried out in all patients, after which IVF-ET was performed.The pregnancy rate and ectopic pregnancy rate were calculated. Results Embolization of both fallopian tubes was successfully accomplished in all 35 patients. The IVF-ET pregnancy rate was 48.5%(17/35), and no tubal stump pregnancy occurred. Conclusion The use of interventional embolization to occlude tubal stump can effectively avoid the occurrence of tubal stump pregnancy.
Objective To investigate the clinical characteristics of tubal stump pregnancy, and to assess the value of interventional embolization in preventing tubal stump pregnancy. Methods Among the patients who were planned to receive preoperative treatment of hydrosalpinx before the performance of in vitro fertilization-embryo transfer(IVF-ET) at authors' hospital, 35 patients had stump of fallopian tube. Of the35 patients, previous surgery of unilateral fallopian tube was present in 28 and previous surgery of bilateral fallopian tubes in 7. The length of tubal stump ranged from 10 mm to 45 mm, with a mean of 25 mm.Interventional embolization with micro-coils was carried out in all patients, after which IVF-ET was performed.The pregnancy rate and ectopic pregnancy rate were calculated. Results Embolization of both fallopian tubes was successfully accomplished in all 35 patients. The IVF-ET pregnancy rate was 48.5%(17/35), and no tubal stump pregnancy occurred. Conclusion The use of interventional embolization to occlude tubal stump can effectively avoid the occurrence of tubal stump pregnancy.
引文
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[13]Strandell A,Thorburn J,Hamberger L,et al.Risk factors for ectopic pregnancy in assisted reproduction[J].Fertil Steril,1999,71:282-286.
[14]Weigert M,Gruber D,Pernicka E,et al.Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in in vitro fertilization-embryo transfer patients[J].J Assist Reprod Genet,2009,26:13-17.
[15]Mohan S,Thomas M.Ectopic pregnancy:reappraisal of risk factors and management strategies[J].Int J Reprod Contracept Obstet Gynecol,2015,4:709-715.
[16]张宝丽,杨柳,张学红,等.胚胎移植术后17例宫内外同时妊娠分析及文献复习[J].生殖医学杂志,2016,25:22-26.
[17]朱蕾蕾.宫腔镜输卵管近端栓塞术在体外受精-胚胎移植前预处理输卵管积水中的应用[J].国际生殖健康/计划生育杂志,2015,34:145-147.
[18]冯长征,石宇,杨朝湘,等.介入栓塞替代结扎处理体外受精-胚胎移植前输卵管积水[J].中国妇幼保健,2014,23:3944-3946.
[19]洪鑫,丁文彬,张勤,等.介入栓塞术治疗输卵管积水对体外受精-胚胎移植结局的影响[J].交通医学,2015,29:523-525.
[20]钱朝霞,陈克敏,宋富珍,等.栓塞治疗输卵管积水对体外授精-胚胎移植结局的影响[J].介入放射学杂志,2014,23:311-313.
[21]杨菁,王雅琴.输卵管积水及其治疗对胚胎种植影响的评价[J].生殖与避孕,2014,34:584-589.
[2]Johnson NP,Mak W,Sowter MC.Surgical treatment for tubal disease in women due to undergo in vitro fertilization[J].Cochrane Database Syst Rev,2004:CD002125.
[3]Orazi G,Cosson M.Surgical treatment of ectopic pregnancy[J].J Gynecol Obstet Biol Reprod(Paris),2003,32(7 Suppl):S75-S82.
[4]刘桂淑,欧海燕,陈艺.输卵管显微整复术的解剖基础和临床应用[J].解剖与临床,2002,7:96-97.
[5]Pan J,Qian Y,Wang J.Bilateral interstitial pregnancy after in vitro fertilization and embryo transfer with bilateral fallopian tube resection detected by transvaginal sonography[J].J Ultrasound Med,2010,29:1829-1832.
[6]Iwama H,Tsutsumi S,Igarashi H,et al.A case of retroperitoneal ectopic pregnancy following IVF-ET in a patient with previous bilateral salpingectomy[J].Am J Perinatol,2008,25:33-36.
[7]Song T,Lee DH,Kim HC,et al.Laparoscopic tube preserving surgical procedures for ectopic tubal pregnancy[J].Obstet Gynecol Sci,2016,59:512-518.
[8]Grimstad FW,Nangia AK,Luke B,et al.Use of ICSI in IVF cycles in women with tubal ligation does not improve pregnancy or live birth rates[J].Hum Reprod,2016,31:2750-2755.
[9]张霞.输卵管结扎术后并发症的研究分析及预防措施[J].中国继续医学教育,2016,14:143-144
[10]王玢,周建军,刘景瑜,等.异位妊娠后行体外受精-胚胎移植的临床结局分析[J].生殖医学杂志,2015,24:392-396.
[11]Knutzen V,Stratton CJ,Sler G,et al.Mock embryo transfer in the early luteal phase,the cycle before in vitro fertilization and embryo transfer:a descriptive study[J].Fertil Steril,1992,57:156-162.
[12]杨蕴洁,杨芳,杨健之,等.辅助生殖技术后异位妊娠发生的类型及危险因素探讨[J].实用妇产科杂志,2015,31:511-515.
[13]Strandell A,Thorburn J,Hamberger L,et al.Risk factors for ectopic pregnancy in assisted reproduction[J].Fertil Steril,1999,71:282-286.
[14]Weigert M,Gruber D,Pernicka E,et al.Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in in vitro fertilization-embryo transfer patients[J].J Assist Reprod Genet,2009,26:13-17.
[15]Mohan S,Thomas M.Ectopic pregnancy:reappraisal of risk factors and management strategies[J].Int J Reprod Contracept Obstet Gynecol,2015,4:709-715.
[16]张宝丽,杨柳,张学红,等.胚胎移植术后17例宫内外同时妊娠分析及文献复习[J].生殖医学杂志,2016,25:22-26.
[17]朱蕾蕾.宫腔镜输卵管近端栓塞术在体外受精-胚胎移植前预处理输卵管积水中的应用[J].国际生殖健康/计划生育杂志,2015,34:145-147.
[18]冯长征,石宇,杨朝湘,等.介入栓塞替代结扎处理体外受精-胚胎移植前输卵管积水[J].中国妇幼保健,2014,23:3944-3946.
[19]洪鑫,丁文彬,张勤,等.介入栓塞术治疗输卵管积水对体外受精-胚胎移植结局的影响[J].交通医学,2015,29:523-525.
[20]钱朝霞,陈克敏,宋富珍,等.栓塞治疗输卵管积水对体外授精-胚胎移植结局的影响[J].介入放射学杂志,2014,23:311-313.
[21]杨菁,王雅琴.输卵管积水及其治疗对胚胎种植影响的评价[J].生殖与避孕,2014,34:584-589.