不育患者不同程度盆腔粘连的相关因素探讨

目的探讨不育患者盆腔粘连的相关因素及与盆腔粘连程度的关系。方法选择接受腹腔镜诊治的合并不同程度的盆腔粘连不育症患者319例,根据盆腔的粘连致密程度、粘连范围、有无子宫直肠窝封闭、双侧卵巢输卵管是否与周围组织粘连,输卵管是否闭锁等进行评分。根据评分分组:轻度粘连组122例,中度粘连组84例,重度粘连组113例。对照组87例为同期接受腹腔镜检查,术中未发现盆腔粘连的不育症患者。结果(1)不同程度盆腔粘连患者的盆腹腔手术史发生率均显著高于对照组(16.4%,26.2%,20.4%vs 3.5%,P<0.01);盆腔炎史发生率对照组和轻度粘连组显著低于重度粘连组(6.9%,4.1%vs 15.0%,P<0.05,P<0.01)。(2)腹腔镜下诊断盆腔结核发病率重度粘连组显著高于对照组和轻度粘连组(7.1%vs 0%,0.8%,P<0.05);各粘连组输卵管梗阻、输卵管积液/积脓发生率均显著高于对照组(21.1%,27.6%,49.1%vs 9.9%,P<0.05)、(5.7%,10.7%,18.6%vs 0%,P<0.05);(3)腹腔镜下诊断卵巢内异囊肿的发生率各粘连组均显著高于对照组(6.6%,15.5%,10.6%vs 0%,P<0.05)。结论手术损伤、盆腔炎症和子宫内膜异位症是造成不育患者盆腔粘连的重要因素,并与盆腔粘连的严重程度密切相关。

Analysis of the factors associated with pelvic adhesions in infertility women

Objective: To explore the related factors with different degrees of pelvic adhesion in infertility women by laparoscopy.Methods:Three-hundred and nineteen infertile patients who were found with pelvic adhesion by laparoscopy were recruited.They were divided into three groups according to the severity of pelvic adhesion as follow: 122 with mild adhesion,84 with moderate adhesion and 113 with severe adhesion.There were 87 infertile patients without pelvic adhesion in the control group.Results:(1) There were much higher percentage of patients who had surgery history in each of the pelvic adhesion groups than the control group(16.4%,26.2%,20.4% vs 3.5%,P<0.01).There were lower percentage of patients who had past pelvic inflammation in control group and mild adhesion group than those in severe adhesion group(6.9%,4.1% vs 15.0%,P<0.05,P<0.01).(2) The incidence of pelvic tuberculosis in the severe adhesion group was higher than that in control and mild adhesion group by laparoscopy(7.1% vs 0%,0.8%,P<0.05).The rates of tubal obstruction and hydropyosalpinx in all of the pelvic adhesion groups were significantly higher than those in control group(21.1%,27.6%, 49.1% vs 9.9% and 5.7%,10.7%,18.6% vs 0%,respectively,P<0.05).(3)The rates of ovarian endometriosis in all of the pelvic adhesion groups were significantly higher than these in control group(6.6%,15.5%,10.6% vs 0%,P<0.05).Conclusions:Abdominal or pelvic operative lesions,pelvic inflammation and endometriosis could be important factors to induce pelvic adhesion in infertility women,and the incidence of those diseases is correlated with the severity of pelvic adhesion.