超声引导下胚胎移植术中的导管选择是否会影响结果?

分类:医学文献 35 0

The immediate identification of the catheter may provide a method for precise, atraumatic embryo transfer (1). The combination of a modern catheter and ultrasound allows visual monitoring of the entire embryo transfer process while navigating embryo placement within the uterine cavity with high precision. A recent development is the availability of the soft Wallace echogenic catheter (SureView Wallace Embryo Transfer Catheter), which utilizes new technology specifically designed to visually enhance the catheter’s appearance under ultrasound. The Wallace SureView Embryo Transfer Catheter (Figure 1) combines the advantages of the traditional ultra-soft Wallace catheter and the echogenic properties that make the entire length of the catheter visible to the physician doing the embryo transfer during ultrasonographic guidance. The attending physician can be more accurate regarding the embryo deposition site when using the SureView catheter.

迅速识别导管可以为精准,无创伤的胚胎移植提供一种方式(1)。现代导管和超声波技术的结合使用,可以帮助我们从视觉上监控整个胚胎移植过程,同时可以高精度地将胚胎移植进子宫腔内。当前,最新使用的是导管是Wallace回声软导管(SureView Wallace胚胎移植导管),该导管采用了专门设计的新技术,可以在超声波引导下从视觉上增强导管的外观。Wallace SureView胚胎移植导管(图1)结合了传统超软Wallace导管的优点和回声特性,使医师在经超声波引导下行胚胎移植手术时看见整个导管的存在。使用SureView导管时,主治医师可以更准确地了解胚胎的着位点。

Figure 1 Cross-section of the SureView Catheter

SureView导管的横截面

It has been postulated that new echodense catheters that are more readily detectable by ultrasound may refine transfer techniques, thus improving the IVF outcome (2). The use of the echodense catheter facilitates catheter identification under ultrasound and, thus, reduces the duration of the embryo transfer procedure. The time elapsed from when the loaded catheter was handed to the physician up to embryo discharge was significantly shorter in the echogenic catheter group than in the standard catheter group (2).

有研究人员推测,更容易被超声波检测到的新回声导管可以改善胚胎移植技术,从而改善试管周期结果(2)。回声导管的使用促进了超声波引导下的导管识别过程,减少了胚胎移植手术的持续时间。与使用标准导管组相比,回声导管组从医生拿到装配好的导管起到医生释放胚胎时所经历的时间明显缩短(2)。

Karande et al. (3) compared the performance of a new coaxial catheter system with an echo-dense tip (Cook Echo-Tip catheter) with a Wallace catheter during ultrasound-guided embryo transfer in a prospective, randomized study on 251 patients undergoing ultrasonography-guided embryo transfer by a single physician with a standardized technique. The reported no significant difference in the implantation rate (30% vs. 35%), clinical pregnancy rate (57% vs. 55%), or the ongoing pregnancy rate (49% vs. 47%) between the two catheters and concluded that the Cook Echo-Tip catheter, with its echogenic tip, simplifies the embryo transfer. However, it does not significantly impact pregnancy success rates in comparison with the use of a Wallace catheter.

Karande等人(3)做了一项前瞻性研究,比较了使用带有超声活检针的新型同轴导管(库克Echo-Tip导管)和Wallace导管后的结果,受试者为251名在超声波引导下行胚胎移植术的患者,移植医生为同一位医生并使用相同标准的移植技术。结果发现,使用这两种导管的移植成功率(30%对比35%),临床妊娠率(57%对比55%)或持续妊娠率(49%对比47%)无显著差异,研究人员得出结论:带有活检针的库克Echo-Tip导管虽然可以简化胚胎移植过程,但是与使用Wallace导管相比,并不会显著影响妊娠率。

Coroleu et al. (2) conducted a prospective, randomized, controlled trial to compare the IVF outcome in women undergoing embryo transfer with either the standard soft Wallace Catheter (standard catheter group, n=95) or the new echogenic soft Wallace catheter (echogenic catheter group, n=98) under ultrasound guidance by a single healthcare provider. Women were randomly assigned to either of the groups, according to a computer-generated randomization table. There were no significant differences in the clinical pregnancy rates between the standard catheter and echogenic catheter groups (41.0% vs. 54.1%, respectively; P<0.08). However, the authors interpreted the significantly high twin pregnancy rate (p<0.01) in the echogenic catheter group as the underlying source for obtaining a significant increase in implantation rate in this group (37.1%) as compared with the standard catheter group (23.2%). They also concluded that although the use of the echogenic Wallace catheter simplifies ultrasound-guided embryo transfer, no definite benefit in terms of pregnancy rates was obtained.

Coroleu等人(2)也进行了一项前瞻性随机对照试验,比较了同一位医生在使用标准Wallace软导管(标准导管组,n=95)和使用了新的回声Wallace软导管(回声导管组,n=98)后的结果差异。研究人员根据计算机生成的随机对照表,将女性患者随机分配到任一组中。结果显示,标准导管组和回声导管组之间的临床妊娠率无显著差异(分别为41.0%和54.1%;P<0.08)。但是,他们发现回声导管组的双胎妊娠率(37.1%)显著高于标准导管组(23.2%)(P<0.01)。因此他们得出结论,尽管使用具有回声功能的Wallace导管简化了经超声引导下的胚胎移植手术,但是并未显著改善妊娠结果。

Wood et al. (4) evaluated two different embryo transfer techniques of potential clinical importance, performed in 518 cycles over two contiguous time periods in order to observe any corresponding change in clinical pregnancy rate per transfer: (1) embryo transfer catheter; (2) ultrasound guidance. Ultrasound visualization was considered to be excellent/good when the catheter could be followed from the cervix to the fundus by transabdominal sonography with retention of the embryo-containing fluid droplet; and fair/poor if visualization could not document the sequence of events. The CPR was significantly higher with the use of the soft catheters compared with the use of the hard catheters (36% vs. 17% respectively; P<0.000). The clinical pregnancy rate per transfer was significantly higher in the ultrasound guidance group (38% vs. 25%; P<0.002), and in all excellent/good ultrasound-guided transfer (41.5% vs. 16.7%, P<0.038) compared with fair/poor transfers. They concluded that embryo transfer performed with a soft catheter under ultrasound guidance with good visualization resulted in a significant increase in clinical pregnancy rates (4).

Wood等人(4)评估了两种具有潜在临床重要性的胚胎移植技术,他们在两个连续时间段内进行了518个周期,以观察在移植导管和经超声波引导这两个因素变化后每次移植周期的临床妊娠率变化。当可以通过腹部超声检查跟踪带有胚胎液体的导管从宫颈进入子宫到子宫底的过程时,超声可视性被认为是好/良好。如果未能跟踪这些事件过程,则视为一般/差。与使用硬导管相比,使用软导管的临床妊娠率显著提高(分别为17%和36%,P<0.000),经超声引导组每次移植周期的临床妊娠率显著更高(38%对比25%,P<0.002),有良好超声可视性的移植临床妊娠率也显著更高(41.5%对比 16.7%,P<0.038)。他们得出的结论是,经超声引导下使用软导管进行胚胎移植具有良好的可视性,从而导致临床妊娠率显著提高(4)。

However, in contrast to the previously published evidence, Aboulfotouh et al. (5) maintain that, under ultrasound guidance, individual catheter choice does not significantly affect the statistical clinical pregnancy rate in a modern clinical IVF practice, possibly as a result of a decreasing incidence of difficult transfers and endometrial injury at embryo transfer under ultrasound guidance.

不过,Aboulfotouh等人(5)的结论与前述发现不同,他们认为,在超声波引导下,使用何种导管不会显著影响现代临床试管实践中的临床妊娠率统计结果,这可能是因为在胚胎移植过程中使用超声波技术降低了困难移植和对子宫内膜损害的发生率带来的结果。

References

参考文献

1. Letterie GS, Marshall L, Angle M. A new coaxial catheter system with an echodense tip for ultrasonographically guided embryo transfer. Fertil Steril 1999 Aug;72(2): 266-8

2. Coroleu B, Barri PN, Carreras O, et al. Effect of using an echogenic catheter for ultrasound-guided embryo transfer in an IVF programme: a prospective, randomized, controlled study. Hum Reprod 2006;21(7): 1809-15

3. Karande V, Hazlett D, Vietzke M, Gleicher N. A prospective randomized comparison of the Wallace catheter and the Cook Echo-Tip catheter for ultrasound-guided embryo transfer. Fertil Steril 2002; 77(4): 826-30

4. Wood EG, Batzer FR, Go KJ. Gutmann JN, Corson SL. Ultrasound-guided soft catheter embryo transfers will improve pregnancy rates in in-vitro fertilization. Hum Reprod 200; 15(1): 107-12

5. Aboulfotouh I, Abou-Setta AM, Khattab S, Mohsen IA, Askalani A, el-Din RE. Firm versus soft embryo transfer catheters under ultrasound guidance: does catheter choice really influence the pregnancy rates? Fertil Steril 2008;89(5): 1261-2

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