腹腔镜在不孕症诊断和治疗中的应用

目的评价腹腔镜在不孕症诊断和治疗中的临床应用价值。方法应用腹腔镜,对98例继发性不孕症和32例原发性不孕症妇女进行腹腔镜诊断和治疗,并对其资料进行分析。结果经腹腔镜检查,原发性不孕症32例,其中多囊卵巢28例,不明原因4例;继发性不孕98例,其中发现盆腔器质性病变93例,检查阳性率为94.9％。慢性盆腔炎、盆腔粘连和子宫内膜异位症是引起继发性不孕的主要盆腔疾病,占继发性不孕的93.2％。其中慢性盆腔炎、盆腔粘连占52.1％(51/98);子宫内膜异位症占42.8％(42/98)。慢性盆腔炎、盆腔粘连患者中94.1％(48/51)有一侧或双侧慢性输卵管梗阻;子宫内膜异位症患者中仅9.5％(4/42)有输卵管梗阻。盆腔炎、盆腔粘连者多无急性盆腔炎病史,66.6％(34/51)没有自觉症状。腹腔镜下给予相应的治疗,术后30％(39/130)受孕。结论生殖道炎症及盆腔感染是继发性不孕的重要病因,其症状隐匿,易被忽视,应引起临床医生的高度重视。腹腔镜技术对不孕症的诊断和治疗有重要价值,起到了诊断治疗一体化的作用。

Laparoscopy in the Management of Secondary and Inferitility

Objective To investigate the cause of primary and secondary infertility and evaluate the value of laparoscopy in diagnosis and therapy of infertility. Methods primary infertility in 10 female patients and secondary infertility in 98 cases were explored and treated by la- paroscopy, the diagnostic and therapeutic effectiveness was analyzed. Results 93 of 98 cases with secondary infertility (94.9%) had pelvic dis- eases. Pelvic inflammatory disease/pelvic adhesions and endometriosis were major causes resulting in secondary infertility, approximately 93.2 %. The first cause of secondary infertility was pelvic inflammatory disease/pelvic adhesions (52.1%) and the second was endometriosis (42.8%) There were 94.1% patients with pelvic inflammatory disease/pelvic adhesions and 9.5% with endometriosis presented fallopian obstruction. Most of the patients with pelvic inflammatory disease/pelvic adhesions didn't have history of acute process and 66.6% were asymptomatic. The first cause of primary infertility were poly-cystic ovary (87.5%). In all cases, the pregnant recurrence rate reached 30% (39/130). Con- clusion Genital inflammatory disease and pelvic inflammatory disease are the important causes of secondary infertility which deserve to be drawn attention. The important value of laparoscopy in diagnosis primary and secondary infertility is that it could definite the pelvic cause and direct treatment.