宫腹腔镜联合导丝介入诊治输卵管性不孕症100例分析

摘要

目的:了解宫腹腔镜联合导丝介入诊治输卵管阻塞性不孕症的临床意义.方法:对2007年6月～2010年12月因不孕症在我科行宫腹腔镜联合检查下导丝介入术的100例患者的临床资料进行回顾性分析.在腹腔镜下观察输卵管情况及亚甲蓝通液情况,对阻塞的输卵管行COOK导丝疏通术,同时行宫腹腔镜治疗性操作.结果:①100例患者中,膜性粘连8例,行粘连分解,见双侧输卵管亚甲蓝流出顺畅无阻塞.单侧美兰流出顺畅12例(14.06%),子宫输卵管造影(HSG)呈假阳性.24条输卵管壶腹部扩张伞端包裹行造口术.②术中发现盆腔病变57例,占57%,慢性盆腔炎居首位,内移症居第二位,内膜结核为第三位,多囊卵巢综合征为第四位.术中行粘连分解、内移症清除术和多囊卵巢打孔术.对广泛致密粘连无法恢复功能的未做治疗2例.③宫腔镜下见子宫内膜炎居首,息肉次之.术中对宫腔炎性粘连分解、打开输卵管开口及息肉切除,对结核性宫腔粘连瘢痕未作处理.术后两年内累计妊娠率达41.0%.结论:宫腹腔镜下导丝介入集三种手术于一体,同时兼有诊断治疗的双重作用,缩短了治疗时间,节省了费用,对输卵管Ⅰ期阻塞疗效确切,同时对下一步治疗有指导作用.%Objective: To explore the clinical significance of wire intervention therapy under the guidance of hysteroscope and laparoscope in the treatment of tubal infertility. Methods: the clinical data of 100 patients in our department from June 2007 to December 2010 was retrospectively analyzed, these patients undergone wire intervention therapy under the guidance of hysteroscope and laparoscope. The situation of tubal and Methylene blue liquid examination were observed under laparoscope, followed by COOK wire dredge operation for the blocked oviducts and therapeutic procedure under hysteroscope. Results: ①8 cases out of 100 patients had membrane adhesion, the adhesion was separated and there was Methylene blue liquid outflowed from the bilateral tubal. 12 cases had one side blockage, false positive of HSG was 14.06%. 24 tubules underwent ostomy at the tubal ampulla umbrella. ②57 patients (57%) were identified with pelvic lesion, and pelvic inflammation as the predominant reason, followed by endometriosis, polycystic ovary syndrome and tuberculosis. The procedures were consisted with adhesion decomposition, endometriosis clearance and drilling of the polycystic ovary. No procedures were tried for the least promising function recovery of severe adhesion. ③Endometritis and polyps were the first and second lesions by hysteroscope. The procedures were consisted with adhesion decomposition of the endometriosis, fenestration of the oviducts and excision of polyps. No procedure was performed for the tuberculous scars. The pregnancy rates were accumulated to 41.8% in two years after operation. Conclusion: The wire intervention operation under the guidance of hysteroscope and laparoscope show a significance of diagnosis and therapy. The procedure time is shortened and more cost is saved, especially for the class I blockage. It is also important for guiding the following therapy.