發(fā)布時間：2018-10-29 16:34

【摘要】：研究目的：分析卵巢內(nèi)異囊腫剝除術(shù)后不同時間進(jìn)行體外受精-胚胎移植(In vitrofertilization--embryo transfer,IVF-ET)的結(jié)局,比較不同促排卵方案在其中的作用,為卵巢內(nèi)異囊腫剝除術(shù)后患者選擇IVF-ET時機(jī)以及促排卵方案提供依據(jù)。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(xué)附屬婦產(chǎn)科醫(yī)院生殖內(nèi)科進(jìn)行IVF-ET的297例有卵巢內(nèi)異囊腫剝除手術(shù)史的中重度內(nèi)異不孕患者的臨床、實(shí)驗(yàn)室及隨訪資料。按取卵手術(shù)與囊腫剝除術(shù)間隔時間分為五組,分別為3個月內(nèi)、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(jié)局指標(biāo)。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(jié)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(jié)局的影響。研究結(jié)果：卵巢內(nèi)異囊腫剝除術(shù)后4-6個月行取卵手術(shù)患者在胚胎植入率,臨床妊娠率和活產(chǎn)率上都高于其他各組,但在統(tǒng)計學(xué)上無顯著差異。術(shù)后6個月內(nèi)行取卵手術(shù)患者的胚胎植入率,臨床妊娠率,活產(chǎn)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(chǎn)率也高于使用長方案,但統(tǒng)計學(xué)上無顯著差異。使用長方案的患者中,卵巢內(nèi)異囊腫剝除術(shù)后3個月內(nèi)行取卵手術(shù)的6名患者均未實(shí)現(xiàn)臨床妊娠；4-6個月組的臨床妊娠率和活產(chǎn)率最高,分別為57.69%和50.00%；6個月后隨著取卵手術(shù)與囊腫剝除術(shù)間隔時間延長,臨床妊娠率和活產(chǎn)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(chǎn)率未見顯著差異。卵巢內(nèi)異囊腫剝除術(shù)24個月后行取卵手術(shù)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(chǎn)率43.90%也顯著高于長方案組17.14%(p=0.012)。結(jié)論：對重度內(nèi)異不孕患者來說,術(shù)后6個月內(nèi)進(jìn)入IVF-ET周期更能獲益,4-6個月可能是卵巢內(nèi)異囊腫剝除術(shù)與IVF-ET的最佳間隔時間。而對卵巢內(nèi)異囊腫剝除術(shù)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(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R713.6;R714.8

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