本文選題：輸卵管性不孕 + 妊娠結(jié)局��； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：研究背景： 輸卵管性不孕(Tubal factor infertility，TFI),是指由于各種因素形成輸卵管管壁肌肉收縮功能及上皮纖毛蠕動減弱或輸卵管粘連、積水及阻塞等，引起輸卵管傘端拾取卵子及運送受精卵進入宮腔著床的功能喪失，導(dǎo)致女性不孕。近年來，一方面由于晚婚、晚育、人工流產(chǎn)次數(shù)的增加及性傳播疾病的增加，輸卵管性不孕的發(fā)病率有增高趨勢；另一方面由于腹腔鏡技術(shù)在女性不孕中應(yīng)用的普及，輸卵管因素在女性生育功能中的重要地位越來越受到關(guān)注。輸卵管性不孕具有發(fā)病率高、病因多樣、療效欠佳的特點，其嚴(yán)重影響患者的身心健康和家庭和諧。 目前，輸卵管性不孕常用的診療方法有輸卵管通液術(shù)、子宮輸卵管造影、宮腔鏡插管通液術(shù)等。目前宮腹腔鏡聯(lián)合探查術(shù)被認(rèn)為是輸卵管性不孕診療的金標(biāo)準(zhǔn)。其治療效果的差異跟病例選擇及患者盆腔粘連、輸卵管病變程度、輸卵管通暢情況等有密切相關(guān)性。而IVF-ET的出現(xiàn)解決了輸卵管性不孕患者精卵結(jié)合障礙的問題，且有較高的妊娠率，但花費較高。目前臨床尚沒有統(tǒng)一的治療輸卵管性不孕的標(biāo)準(zhǔn)，本研究回顧性分析宮腹腔鏡聯(lián)合輔助生殖技術(shù)治療輸卵管性不孕妊娠結(jié)局及相關(guān)因素，探討如何改善輸卵管性不孕的妊娠結(jié)局，為臨床治療提供參考。 目的：通過分析宮腹腔鏡及聯(lián)合輔助生殖技術(shù)治療的輸卵管性不孕患者，探討其術(shù)后自然受孕率，術(shù)后最佳受孕時間、分析各影響因素與受孕率的關(guān)系，術(shù)后接受輔助生殖助孕的最佳時間。為臨床醫(yī)師綜合輸卵管性不孕患者的整體情況以指導(dǎo)患者掌握最佳的妊娠時機并獲得最高妊娠率。 資料與方法： 1研究對象 2010年1月至2010年12月期間在鄭州大學(xué)第三附屬醫(yī)院因輸卵管性不孕住院行宮腹腔鏡手術(shù)的426例患者,符合標(biāo)準(zhǔn)207例，在隨訪過程中，失訪21例，共隨訪到186例納入本研究，其中5例因輸卵管妊娠切除患側(cè)輸卵管，共367條輸卵管，其中原發(fā)不孕73例，繼發(fā)不孕113例。 2研究方法 電話隨訪術(shù)后6個月、12個月、18個月的妊娠情況;根據(jù)術(shù)后是否自然受孕分為自然受孕組和未自然受孕組。6個月后未自然受孕組中，其中54例患者接受體外受精-胚胎移植(IVF-ET)，電話隨訪其是否受孕，根據(jù)其接受IVF助孕后是否妊娠分為IVF妊娠組和IVF未妊娠組。兩組之間的觀察指標(biāo)包括患者一般資料如年齡、不孕年限、不孕類別；患者的既往手術(shù)史如人工流產(chǎn)史、盆腔手術(shù)史、輸卵管妊娠史；患者行宮腹聯(lián)合的術(shù)中情況包括盆腔粘連程度、輸卵管積水程度(通過目測)、術(shù)中治療后輸卵管通暢情況。 3統(tǒng)計學(xué)方法 將相關(guān)變量進行編碼后錄入Excel表格。使用SPSS17.0統(tǒng)計軟件分析數(shù)據(jù)，檢驗水準(zhǔn)α=0.05，基本情況的比較用χ2檢驗、獨立樣本T檢驗。對影響妊娠結(jié)局的相關(guān)因素先進行單因素Logistic回歸分析，將有統(tǒng)計學(xué)意義（P＜0.1）的因素引入多因素Logistic回歸分析。 結(jié)果： 1.妊娠率：186例患者宮腹腔鏡術(shù)后總自然受孕69例，總自然受孕率為37.10%（69/186）；宮腹腔鏡術(shù)后6月內(nèi)55例自然妊娠，術(shù)后0-6月自然受孕率為29.57%(55/186)；術(shù)后7月至12月之間12例自然受孕，術(shù)后0-12月內(nèi)累計自然受孕率為36.02%(55+12/186)；12月后自然受孕2例，術(shù)后0-18月累計自然受孕率為37.10%(55+12+2/186)；宮腹腔鏡術(shù)后6個月未自然受孕者行IVF的有54例患者，其中28例妊娠，IVF累計妊娠率為51.85%(28/54)。 2.宮腹腔鏡術(shù)后自然受孕率影響因素的相關(guān)分析： 一般資料：單因素及多因素分析結(jié)果顯示:年齡P0.05，回歸系數(shù)β為-0.125；不孕年限P0.05，回歸系數(shù)β為-0.281；不孕類別P0.05，回歸系數(shù)β為-0.4；可以認(rèn)為不孕年限是影響宮腹腔鏡術(shù)后自然受孕率的負(fù)相關(guān)因素，在控制其他因素不變的條件下，隨不孕年限的增長，自然受孕率下降。年齡和不孕類別不是自然受孕率的影響因素。 既往手術(shù)史：單因素及多因素分析結(jié)果顯示:人工流產(chǎn)史P0.1，回歸系數(shù)β為-0.229；盆腔手術(shù)史P0.1，回歸系數(shù)β為-0.394；輸卵管妊娠史P0.05，回歸系數(shù)β為-1.871，卡方分析χ2為0.747，P0.05，差異無統(tǒng)計學(xué)意義；故人工流產(chǎn)史、盆腔手術(shù)史、輸卵管妊娠史不是影響宮腹聯(lián)合術(shù)后自然受孕率的影響因素。 術(shù)中情況：單因素及多因素分析結(jié)果顯示：盆腔粘連P0.05，回歸系數(shù)β為-0.98，卡方分析χ2為3.22，P0.05，差異有統(tǒng)計學(xué)意義；輸卵管積水程度P0.05，回歸系數(shù)β為-0.85，卡方分析χ2為0.27，P0.05，差異有統(tǒng)計學(xué)意義；輸卵管通暢情況P0.05，回歸系數(shù)β為0.743，卡方分析χ2為4.947，P0.05，差異有統(tǒng)計學(xué)意義；可以認(rèn)為盆腔粘連程度、輸卵管積水程度是影響自然受孕率的負(fù)相關(guān)因素，即在控制其他因素不變的條件下，隨著盆腔粘連程度及輸卵管積水程度的加重，自然受孕率降低。輸卵管通暢情況是影響自然受孕率的正相關(guān)因素。即在控制其他因素不變的條件下，，輸卵管雙側(cè)通暢的自然妊娠率高于單側(cè)通暢的自然受孕率。 綜上可知：不孕年限、盆腔粘連程度、輸卵管積水程度是影響宮腹腔鏡術(shù)后自然受孕率的負(fù)相關(guān)因素，輸卵管通暢情況是正相關(guān)因素。 3.宮腹腔鏡術(shù)后自然受孕失敗行IVF妊娠率的影響因素的相關(guān)分析 一般資料：單因素及多因素分析結(jié)果顯示:年齡P0.05，回歸系數(shù)β為-0.473；不孕年限P0.05，回歸系數(shù)β為-0.042；不孕類別P0.05，回歸系數(shù)β為-0.048；可以認(rèn)為年齡是影響IVF妊娠率的負(fù)相關(guān)因素，即在控制其他因素不變的條件下，隨年齡增長，IVF妊娠率下降；不孕年限和不孕類別不是影響IVF妊娠率的相關(guān)因素。 既往手術(shù)史：單因素及多因素分析結(jié)果顯示:人工流產(chǎn)史P0.1，回歸系數(shù)β為-0.336；盆腔手術(shù)史P0.1，回歸系數(shù)β為-0.357；輸卵管妊娠史P0.1，回歸系數(shù)β為-0.077;故人工流產(chǎn)史、盆腔手術(shù)史、輸卵管妊娠史不是影響IVF妊娠率的影響因素。 術(shù)中情況：單因素及多因素分析結(jié)果顯示：盆腔粘連P0.05，回歸系數(shù)β為-0.457;輸卵管積水程度P0.05，回歸系數(shù)β為-0.95;輸卵管通暢情況P0.05，回歸系數(shù)β為-0.223；可以認(rèn)為盆腔粘連程度、輸卵管積水通暢情況不是影響IVF妊娠率的相關(guān)因素，輸卵管積水程度是影響IVF妊娠率的負(fù)相關(guān)因素。即在控制其他因素不變的條件下，隨著輸卵管積水程度的加重，IVF妊娠率降低。由上可知，年齡、輸卵管積水程度是影響術(shù)后自然受孕失敗行IVF妊娠率的負(fù)相關(guān)因素。 結(jié)論： 1.輸卵管性不孕患者行宮腹腔鏡術(shù)后6月內(nèi)自然受孕率最高，臨床指導(dǎo)患者術(shù)后應(yīng)盡早試孕，以獲得最佳妊娠結(jié)局。 2.不孕年限較短、無盆腔粘連或程度較輕、無輸卵管積水或程度較輕的輸卵管性不孕患者行宮腹腔鏡術(shù)后自然受孕率較高，可期待自然受孕；不孕年限較長、盆腔粘連程度較重、輸卵管積水程度較重的患者行宮腹腔鏡術(shù)后自然受孕率較低，術(shù)后6月內(nèi)自然受孕失敗的患者應(yīng)盡快接受IVF-ET助孕治療。 3.年齡較大、輸卵管積水程度較重的患者宮腹腔鏡術(shù)后自然受孕率及IVF-ET的妊娠率均較低，建議盡早行IVF-ET治療。
[Abstract]:Research background:
Tubal factor infertility (TFI) refers to the loss of the muscle contraction function of the tube wall of the fallopian tube, the weakening of the peristalsis of the epithelial cilium or the oviduct adherence, water accumulation and obstruction, causing the loss of the function of the oviduct parachute to pick up the eggs and transport the fertilized eggs into the uterine cavity and cause the female infertility. In recent years, one party As a result of late marriage, late childbearing, the increase of the number of abortions and the increase of sexually transmitted diseases, the incidence of tubal infertility is increasing; on the other hand, the importance of fallopian tube factors in female fertility is becoming more and more important because of the popularization of laparoscopy in female infertility. The characteristics of high rate, various causes and poor curative effect seriously affect the patient's physical and mental health and family harmony.
At present, the common methods of diagnosis and treatment of tubal infertility are tubal fluid, hysterossalis, hysterossalis, and hysteroscopic intubation. The combined exploration of uterine laparoscopy is considered as the gold standard for tubal infertility diagnosis and treatment. The difference of the treatment effect is with the choice of the cases and the pelvic adhesion, the degree of fallopian tube and the unobstructed oviduct There is a close correlation between the situation and so on. And the emergence of IVF-ET solves the problem of oviduct infertility in patients with tubal infertility, with high pregnancy rate and high cost. There is no unified standard for the treatment of tubal infertility at present. This study reviewed the retrospective analysis of uterine laparoscopy assisted reproductive technology in the treatment of tubal infertility. To discuss how to improve the pregnancy outcome of tubal infertility, and provide reference for clinical treatment.
Objective: To explore the natural pregnancy rate, the best postoperatively, the relationship between the influence factors and the pregnancy rate, and the best time to receive the assisted reproductive pregnancy after the operation, and the overall situation of the patients with oviductal infertility. To guide patients to master the best timing of pregnancy and obtain the highest pregnancy rate.
Information and methods:
1 research objects
From January 2010 to December 2010, 426 cases of laparoscopic surgery for tubal infertility in the Third Affiliated Hospital of Zhengzhou University met the standard 207 cases. During the follow-up, 21 cases were lost and 186 cases were followed up to the study. 5 cases were cut off the fallopian tube due to tubal pregnancy and 367 fallopian tubes, of which the original was not. There were 73 cases of pregnancy and 113 cases of secondary infertility.
2 research methods
6 months, 12 months, 18 months of pregnancy after 6 months of telephone follow-up; according to whether natural pregnancy was divided into natural pregnancy group and unnatural pregnancy group unnaturally conceived group.6 months later, 54 patients received IVF - embryo transfer (IVF-ET), telephone follow-up was not conceived, according to whether the pregnancy was divided into IVF after IVF pregnancy. Pregnancy group and IVF ungestation group. The observation index between the two groups includes the patient general information such as age, infertile years, infertility category; the history of the patient's previous operation, such as abortion history, pelvic surgery history, tubal pregnancy history, patients with uterine abdominal operation including pelvic adhesion degree, the degree of hydrosalpinx (through visual examination), surgery Tubal patency after treatment.
3 statistical method
The related variables were encoded into the Excel form. Using the SPSS17.0 statistical software to analyze the data and test the level of the alpha =0.05, the basic situation was compared with the x 2 test and the independent sample T test. The single factor Logistic regression analysis was carried out for the related factors affecting the pregnancy outcome, and the factors of the overall planning significance (P < 0.1) were introduced into the multiple factor Logistic. Regression analysis.
Result錛

本文編號：1866068