Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France.
Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France.
Reprod Sci. 2022 Feb;29(2):427-435. doi: 10.1007/s43032-021-00737-6. Epub 2021 Oct 12.
The objective of this paper is to compare assisted reproductive technology (ART) cumulative live birth rates after hysteroscopic proximal tubal occlusion and laparoscopic salpingectomy in endometriosis patients, for management of hydrosalpinx. This is an observational cohort study at a university hospital, including all endometriosis patients with hydrosalpinges undergoing ART, between January 2013 and December 2018. The patients underwent either laparoscopic salpingectomy or hysteroscopic proximal tubal occlusion with Essure® when laparoscopy was not an option (extensive pelvic adhesions at exploratory laparoscopy or a history of multiple abdominal surgeries with frozen pelvis). The diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography (TVUS) and magnetic resonance imaging (MRI). Endometriosis patients with hydrosalpinges diagnosed by hysterosalpingography and/or TVUS and/or MRI were included. The primary outcome was the cumulative live birth rate. A total of 104 patients were included in the study; 74 underwent laparoscopic salpingectomy and 30 underwent proximal tubal occlusion with Essure®. The Essure® group had longer infertility durations (58.9 ± 30.0 months vs. 39.5 ± 19.1 months, p = 0.002) and a higher incidence of associated adenomyosis (76.7% vs. 39.1%, p < 0.001) than the salpingectomy group. The cumulative live birth rate was 56.6% after 44 ART cycles in the Essure® group and 40.5% after 99 ART cycles in the salpingectomy group (p = 0.13). In a population of endometriosis patients undergoing ART, women treated by Essure® for management of hydrosalpinx have similar cumulative live birth rates as women treated by laparoscopic salpingectomy.
本文旨在比较宫腔镜近端输卵管阻塞术和腹腔镜输卵管切除术治疗子宫内膜异位症患者输卵管积水的辅助生殖技术(ART)累积活产率。这是一项在大学医院进行的观察性队列研究,纳入了 2013 年 1 月至 2018 年 12 月期间接受 ART 的所有患有输卵管积水的子宫内膜异位症患者。当腹腔镜检查不可行时(腹腔镜探查时广泛盆腔粘连或既往多次腹部手术伴冰冻骨盆),患者行腹腔镜输卵管切除术或宫腔镜近端输卵管阻塞术(使用 Essure®)。子宫内膜异位症的诊断基于经阴道超声(TVUS)和磁共振成像(MRI)的发表影像学标准。纳入经子宫输卵管造影术(HSG)和/或 TVUS 和/或 MRI 诊断为输卵管积水和子宫内膜异位症的患者。主要结局是累积活产率。本研究共纳入 104 例患者;74 例行腹腔镜输卵管切除术,30 例行 Essure®近端输卵管阻塞术。Essure®组的不孕时间更长(58.9±30.0 个月 vs. 39.5±19.1 个月,p=0.002),合并腺肌病的发生率更高(76.7% vs. 39.1%,p<0.001)。Essure®组在 44 个 ART 周期后累积活产率为 56.6%,腹腔镜输卵管切除术组在 99 个 ART 周期后累积活产率为 40.5%(p=0.13)。在接受 ART 的子宫内膜异位症患者人群中,接受 Essure®治疗输卵管积水的患者与接受腹腔镜输卵管切除术治疗的患者累积活产率相似。