腹腔镜在盆腔粘连致不孕症诊治中的应用——附304例临床分析

目的:探讨腹腔镜手术治疗慢性盆腔炎盆腔粘连所致不孕的效果及盆腔粘连程度等对术后妊娠率的影响。方法:收集经腹腔镜检查诊治的慢性盆腔炎盆腔粘连所致不孕的病例304例,根据术中所见将盆腔粘连程度分为轻、中、重三度,随访术后妊娠情况并探讨手术效果的影响因素。结果:随访到172例患者中术后妊娠64例,妊娠率为37.21%(64/172),异位妊娠率3.49%(6/172),妊娠流产率15.63%(10/64),校正妊娠率为27.91%(48/172)。盆腔轻度粘连者术后妊娠率为50.00%(14/28),明显高于中度病变者(41.82%,46/110)和重度病变者(11.76%,4/34)。不孕时间在≤2年的患者术后妊娠率为61.11%(22/36),明显高于不孕时间在3年以上的患者(34.34%,42/122)。结论:腹腔镜手术治疗慢性盆腔炎盆腔粘连所致不孕的术后妊娠率受盆腔粘连程度及不孕时间等的影响。

Application of laparoscopy in diagnosis and treatment of infertility due to chronic pelvic inflammation and pelvic adhesion

Objective:To evaluate the validity of me laparoscopy for treatment of infertility due to chronic pelvic inflammation and the influence of the degree of pelvic adhesion on the postoperative pregnancy rate.Methods:304 cases whose final diagnosis were infertility due to chronic pelvic inflammation were collected and were classified the degree of pelvic adhesion to mild, moderate and severe.After operation, followed then and discussed the influence of some factors on the result.Results:172 of 304 cases were followed-up. Among them, 64 cases werepregnancy, the postoperative pregnancy rate was 37.21% (64/172), and ectopic pregnancy rate was3.49%(6/172), pregnancy abortion rate was 15.63%(10/64) and the correction pregnancy rate was27.91%(48/172). To patients with mild pelvic adhesion, the postoperative intrauterine pregnancy rate was 53.85%(14/26), which was significantly higher than those with moderate and severe adhesion. The postoperative pregnancy rate of patients being infertile for 1~2 years was 61.11%(22/36) and it was significantly higher than that of patients being infertile for more than 2 years.Conclusion:The postoperative intrauterine pregnancy rate of laparoscopy on infertility due to chronic pelvic inflammation and pelvic adhesion was influenced by the degree of pelvic adhesions, infertility time and patients' age.