Cornual Suture at the Time of Laparoscopic Salpingectomy Reduces the Incidence of Interstitial Pregnancy after In Vitro Fertilization
Cornual Suture at the Time of Laparoscopic Salpingectomy Reduces the Incidence of Interstitial Pregnancy after In Vitro Fertilization
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腹腔镜输卵管切除术时的宫角缝合可降低体外受精后间质妊娠的发生率。
DOI：
10.1016/j.jmig.2018.02.009
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发表时间：
2018-09-01
影响因子：
4.1
通讯作者：
Zhang, Songying
中科院分区：
文献类型：
--
作者：
Chen, Jianmin;Huang, Dong;Zhang, Songying
研究目的：探讨腹腔镜下输卵管切除术时宫角缝合对体外受精（IVF）后间质部妊娠（IP）发生率的影响。回顾性研究（加拿大工作组分类II-2）。设置：大学医院。患者：在IVF胚胎移植前接受输卵管切除术治疗并在我们中心进行管理的输卵管积水患者纳入本研究。干预措施：从2011年4月至2014年3月共542例接受腹腔镜输卵管切除术的患者组成A组。从2014年4月至2016年2月，共有502例患者在腹腔镜输卵管切除术时接受角部缝合，组成B组。测量和主要结果：B组的总体IP率（7/293，2.39%）显著低于A组（27/373，7.24%; p <0.05）。B组的宫内妊娠率和继续妊娠/活产率显著高于A组（均p <0.05）。所有34例IP患者均接受了腹腔镜角造口术和角修复术。11例间质部妊娠和宫内妊娠患者中，7例宫内妊娠足月后剖宫产，4例不可避免流产。34例患者中有8例在胚胎移植后平均23.43 +/-2.77天发生IP破裂。结论：输卵管切除术在输卵管积水患者胚胎移植前的预处理中具有重要作用。输卵管切除术时行宫角缝合有助于降低IP的风险。(C)2018由Elsevier Inc.出版关于AAGL
Study Objective: To investigate the effect of cornual suture at the time of laparoscopic salpingectomy on the incidence of interstitial pregnancy (IP) after in vitro fertilization (IVF).Design: Single-center. retrospective review (Canadian Task Force classification II-2).Setting: University hospital.Patients: Patients with hydrosalpinx who were treated with salpingectomy before IVF-embryo transfer and managed in our center were included in this study.Interventions: A total of 542 patients who underwent laparoscopic salpingectomy from April 2011 to March 2014 comprised group A. A total of 502 patients who underwent cornual suture at the time of laparoscopic salpingectomy from April 2014 to February 2016 comprised group B.Measurements and Main Results: The overall IP rate was significantly lower in group B (7/293, 2.39%) than in group A (27/373, 7.24%; p < .05). The intrauterine pregnancy and ongoing pregnancy/live birth rates were significantly higher in group B than in group A (both p < .05). All 34 patients with IP underwent laparoscopic cornuostomy and cornual repair. Seven of 11 patients with combined interstitial and intrauterine pregnancies carried the intrauterine pregnancy to term and delivered via cesarean section, whereas 4 patients underwent inevitable miscarriage. IP rupture occurred in 8 of 34 patients at a mean of 23.43 +/- 2.77 days after embryo transfer. The earliest time of rupture was on day 20 after embryo transfer.Conclusion: An optimized salpingectomy technique plays an important role in pretreatment before embryo transfer in patients with hydrosalpinx. Cornual suture at the time of salpingectomy helps reduce the risk of IP. (C) 2018 Published by Elsevier Inc. on behalf of AAGL.