【摘要】：研究目的：分析卵巢內異囊腫剝除術后不同時間進行體外受精-胚胎移植(In vitrofertilization--embryo transfer,IVF-ET)的結局,比較不同促排卵方案在其中的作用,為卵巢內異囊腫剝除術后患者選擇IVF-ET時機以及促排卵方案提供依據。研究方法：回顧性分析2010年1月1日至2014年12月31日于浙江大學附屬婦產科醫(yī)院生殖內科進行IVF-ET的297例有卵巢內異囊腫剝除手術史的中重度內異不孕患者的臨床、實驗室及隨訪資料。按取卵手術與囊腫剝除術間隔時間分為五組,分別為3個月內、4-6個月、7-12個月、13-24個月、24個月后。統(tǒng)計比較各分組的基本情況,以及IVF-ET結局指標。按患者使用的控制性超促排卵方案分為長方案組和超長方案組,比較兩種方案對IVF-ET結局的影響,并分析兩種促排卵方案在各時間分組中對IVF-ET結局的影響。研究結果：卵巢內異囊腫剝除術后4-6個月行取卵手術患者在胚胎植入率,臨床妊娠率和活產率上都高于其他各組,但在統(tǒng)計學上無顯著差異。術后6個月內行取卵手術患者的胚胎植入率,臨床妊娠率,活產率都顯著高于6個月后。超長方案組的胚胎植入率(38.64%)顯著高于長方案組(28.25%)。使用超長方案患者的臨床妊娠率和活產率也高于使用長方案,但統(tǒng)計學上無顯著差異。使用長方案的患者中,卵巢內異囊腫剝除術后3個月內行取卵手術的6名患者均未實現臨床妊娠；4-6個月組的臨床妊娠率和活產率最高,分別為57.69%和50.00%；6個月后隨著取卵手術與囊腫剝除術間隔時間延長,臨床妊娠率和活產率呈下降趨勢。使用超長方案的患者中,不同時間分組的臨床妊娠率和活產率未見顯著差異。卵巢內異囊腫剝除術24個月后行取卵手術患者中,超長方案組的臨床妊娠率為46.34%,顯著高于長方案組的22.86%(p=0.033)；超長方案組的活產率43.90%也顯著高于長方案組17.14%(p=0.012)。結論：對重度內異不孕患者來說,術后6個月內進入IVF-ET周期更能獲益,4-6個月可能是卵巢內異囊腫剝除術與IVF-ET的最佳間隔時間。而對卵巢內異囊腫剝除術后2年以上的患者,可使用超長方案促排卵來增加臨床妊娠成功率。
[Abstract]:Objective: to analyze the outcome of in vitro fertilization and embryo transfer (In vitrofertilization--embryo transfer,IVF-ET) at different time after excision of ovarian heterocyst, and to compare the effects of different ovulation promotion protocols. To provide evidence for the choice of IVF-ET timing and ovulation promotion in patients with ovarian endometriosis after excision. Methods: from January 1, 2010 to December 31, 2014, we retrospectively analyzed the clinical features of 297 cases of moderate and severe infertility with history of ovarian cysts excision in Department of Reproductive Medicine, Department of Obstetrics and Gynecology, affiliated to Zhejiang University, from January 1, 2010 to December 31, 2014. Laboratory and follow-up data. They were divided into five groups according to the interval between oocyte extraction and cystectomy, which were within 3 months, 4 to 6 months, 7 to 12 months, 13 to 24 months and 24 months later respectively. Statistical comparison of the basic situation of each group, as well as IVF-ET outcome indicators. The patients were divided into two groups according to the controlled hyperstimulation of ovulation. The effects of the two schemes on the outcome of IVF-ET were compared, and the effects of the two protocols on the outcome of IVF-ET were analyzed in each time group. Results: the embryo implantation rate, clinical pregnancy rate and live delivery rate were higher in patients undergoing oocyte extraction 4-6 months after excision of ovarian cyst than in other groups, but there was no significant difference in statistics. The embryo implantation rate, clinical pregnancy rate and live delivery rate were significantly higher in patients undergoing oocyte extraction within 6 months after operation than those after 6 months. The embryo implantation rate (38.64%) was significantly higher in the super-long group (28.25%) than in the long group (28.25%). The clinical pregnancy rate and live delivery rate were also higher in patients with long term regimen than in those with long term regimen, but there was no significant difference in statistics. The clinical pregnancy rate and live delivery rate were 57.69% and 50.005% in the 4-6 months group, respectively, among the 6 patients who had undergone oocyte extraction within 3 months after ovarian cyst excision, and the clinical pregnancy rate and the live delivery rate were the highest in the 4-6 month group, and the clinical pregnancy rate was 57.69% in the 4-6 month group, and 57.69% in the 4-6 month group. After 6 months, the clinical pregnancy rate and live delivery rate decreased with the prolongation of the interval between oocyte extraction and cystectomy. There was no significant difference in clinical pregnancy rate and live delivery rate between different time groups in patients with super long regimens. The clinical pregnancy rate in the super-long group was 46.34, which was significantly higher than that in the long regimen group (22.86%) (p0.033). The live birth rate of the super-long regimen group (43.90%) was significantly higher than that of the long plan group (17.14%) (p0. 012). Conclusion: for the patients with severe endometriosis, it is more beneficial to enter the IVF-ET cycle within 6 months after operation, and 4-6 months may be the best interval between the excision of ovarian heterocyst and IVF-ET. For the patients with ovarian endometriosis more than 2 years after excision, ovulation promotion can be used to increase the clinical pregnancy success rate.
【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R713.6;R714.8

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