超声引导下输卵管积水液体抽吸术与输卵管切除术在接受体外受精-胚胎移植且超声可见输卵管积水患者管理中的比较：一项随机对照试验
Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET: a randomized controlled trial.
作者信息
Fouda Usama M, Sayed Ahmed M, Abdelmoty Hatem I, Elsetohy Khaled A
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt,
出版信息
BMC Womens Health. 2015;15:21. doi: 10.1186/s12905-015-0177-2. Epub 2015 Feb 27.
BACKGROUND
The aim of this study was to compare the efficacy of ultrasound guided aspiration of hydrosalpinx fluid at the time of oocyte retrieval with salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET.
METHODS
One hundred and sixty patients with ultrasound visible hydrosalpinx were randomized into salpingectomy group and aspiration group using computer generated randomization list and sequentially numbered sealed envelopes containing allocation information written on a card.
RESULTS
The clinical pregnancy rate per started cycle and the implantation rate were non- significantly higher in the salpingectomy group compared with the aspiration group [40% vs. 27.5% (p value = 0.132) and 18.95% vs. 12.82% (p value =0.124), respectively]. In the aspiration group, 34.21% of patients had rapid re-accumulation of the hydrosalpinx fluid (i.e. within first two weeks after embryo transfer). Whereas, the clinical pregnancy rate per transfer cycle and the implantation rate were significantly higher in salpingectomy group compared with the subgroup of patients with rapid re-accumulation of hydrosalpinx fluid [42.67% vs. 19.23% (p value = 0.036) and 18.95% vs. 7.58% (p value = 0.032), respectively], no significant differences were detected between the salpingectomy group and the subgroup of patients with no re-accumulation of hydrosalpinx fluid (42.67% vs. 34% (p value = 0.356) and 18.95% vs. 15.5% (p value = 0.457), respectively).
CONCLUSION
The small sample size could be the cause of failure of detecting significant increase in implantation and pregnancy rates in salpingectomy group compared with aspiration group. Further larger randomized controlled trials are needed to determine whether salpingectomy is more effective than aspiration of hydrosalpinx fluid or not. Moreover, the data presented in this study suggested that rapid re-accumulation of hydrosalpinx fluid is an obstacle against successful implantation and the cause of lower success rate with ultrasound guided aspiration of hydrosalpinx fluid compared with salpingectomy.
TRIAL REGISTRATION
Clinical trials.gov ( NCT02008240 ), registered 8 December 2013.
背景
本研究旨在比较在体外受精-胚胎移植（IVF-ET）中，取卵时超声引导下抽吸输卵管积水液体与输卵管切除术对超声可见输卵管积水患者的治疗效果。
方法
160例超声可见输卵管积水患者，使用计算机生成的随机列表和按顺序编号的密封信封（信封内装有写在卡片上的分配信息），随机分为输卵管切除组和抽吸组。
结果
与抽吸组相比，输卵管切除组每个启动周期的临床妊娠率和着床率虽有升高，但差异无统计学意义[分别为40% 对27.5%（p值 = 0.132）和18.95% 对12.82%（p值 = 0.124）]。在抽吸组中，34.21%的患者输卵管积水液体迅速重新积聚（即胚胎移植后的前两周内）。然而，与输卵管积水液体迅速重新积聚的亚组相比，输卵管切除组每个移植周期的临床妊娠率和着床率显著更高[分别为42.67% 对19.23%（p值 = 0.036）和18.95% 对7.58%（p值 = 0.032）]，而输卵管切除组与输卵管积水液体未重新积聚的亚组之间未检测到显著差异（分别为42.67% 对34%（p值 = 0.356）和18.95% 对15.5%（p值 = 0.457））。
结论
样本量小可能是输卵管切除组与抽吸组相比未检测到着床率和妊娠率显著升高的原因。需要进一步开展更大规模的随机对照试验，以确定输卵管切除术是否比抽吸输卵管积水液体更有效。此外，本研究数据表明，输卵管积水液体迅速重新积聚是成功着床的障碍，也是超声引导下抽吸输卵管积水液体与输卵管切除术相比成功率较低的原因。
试验注册
ClinicalTrials.gov（NCT02008240），于2013年12月8日注册。
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