| Research Objectives:Tubal factor infertility accounts for 25%-35% of female infertility,and hydrosalpinx is caused by persistent production of tubal fluid despite distal fallopian tubal adhesions and atresia of.Patients with hydrosalpinx are unable to transport oocyte properly,provide a site for fertilization,and deliver fertilized ovum due to the obstruction of tubal blockage dynamics,and the solution is to restore tubal dynamics by surgery or to undergo in vitro fertilization-embryo transfer.In vitro fertilization-embryo transfer technique does not require the fertilized ovum to pass through the fallopian tube,but studies have found that pregnancy and delivery rates are significantly lower in patients with hydrosalpinx after IVF-ET treatment,the retrograde flow of fluid into the uterine cavity mechanically flushes the embryo,resulting in less easy embryo implantation and miscarriage,the effusion with altered physicochemical properties in the hydrosalpinx have toxic effects on the embryo,the hydrosalpinx affects the endometrial receptivity.Evidence-based medical evidence recommends that pretreatment of hydrosalpinx before embryo transfer in patients with hydrosalpinx should be performed to increase the clinical pregnancy rate,and the most widely used pretreatment is laparoscopic tubal surgery.Retrospectively analyzed the clinical data of patients who underwent laparoscopic surgery for hydrosalpinx in the Department of Reproductive Gynecology of our hospital to study the effect of laparoscopic surgery on pregnancy outcome in patients with hydrosalpinx,and provide theoretical basis for future clinical work.Research method:The medical records of patients who underwent laparoscopic surgery for "hydrosalpinx" in the Department of Reproductive Gynecology at the First Hospital of Jilin University from August 2018 to November 2020 were collected,followed up by telephone for postoperative pregnancy,and retrospectively analyzed.SPPP25.0 was used for statistical data analysis.Research results:Of the 107 patients who met the inclusion criteria,5 were lost to follow-up,10 entered the assisted reproduction cycle after bilateral salpingectomy but did not undergo embryo transfer for the time being due to epidemic or personal reasons,and 92 cases were finally included in the statistical analysis.1.GENERAL: Patients were 21-44 years old,with a mean age of31.4 ± 5.5 years.Follow-up: 22 cases were instructed to have intercourse under ultrasound monitoring of ovulation after surgery,8 cases were clinically pregnant and 14 cases were not pregnant;70 cases received IVF-ET treatment,43 cases underwent hydrosalpinx surgery after oocyte retrieval and finally embryo transfer,29 cases(67.4%)were clinically pregnant,27 cases underwent oocyte retrieval and transfer after laparoscopic tubal surgery,22 cases(81.5%)were clinically pregnant.2.Among them,12 patients underwent unilateral/bilateral salpingostomy with 3 intrauterine pregnancies(25%)and 2 ectopic pregnancies(16.7%),8 patients underwent unilateral salpingectomy with3 intrauterine pregnancies(37.5%)and no ectopic pregnancies,and 2patients underwent one-sided salpingostomy and one-sided salpingectomy with no pregnancies.3.70 patients underwent IVF-ET after surgery,including 3 patients who underwent one-sided salpingostomy and one-sided salpingectomy,2cases of intrauterine pregnancy and 1 case of ectopic pregnancy,53 patients who underwent bilateral salpingectomy,36 cases of intrauterine pregnancy and 2 cases of ectopic pregnancy,and 14 patients who underwent unilateral salpingectomy.4.Two cases were graded as mild tubal injury during laparoscopic surgery,and one case was pregnant(50%).In 38 cases with moderate tubal injury,the clinical pregnancy rate was 50% with postoperative natural preparation and 71.4% with IVF-ET.In severe tubal injury,the natural clinical pregnancy rate was 18.2% and the clinical pregnancy rate of IVF-ET was 75.6%.5.Among the 27 cases who underwent laparoscopic tubal surgery before oocyte retrieval,22(81.5%)were pregnant,and among the 43 cases who underwent tubal surgery after oocyte retrieval,29(67.4%)pregnancy outcome and timing of tubal effusion surgery.Conclusion:1.Decreased clinical pregnancy rate and increased ectopic pregnancy rate in patients who underwent unilateral/bilateral salpingostomy compared to those who underwent unilateral salpingectomy under natural pregnancy preparation.2.Increased clinical pregnancy rate and decreased ectopic pregnancy rate in IVF-ET patients after salpingectomy compared to salpingostomy.3.In natural pregnancy preparation,the clinical pregnancy rate after surgery with severe tubal injury was significantly lower than that with moderate tubal injury.In IVF-ET patients,there was no significant correlation between the degree of tubal injury and the clinical pregnancy rate after surgery.4.In IVF-ET patients,there was no significant difference in clinical pregnancy rate between salpingectomy(core-pulling resection)before oocyte retrieval and salpingectomy after oocyte retrieval. |
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