女性不孕症合并盆腔粘连腹腔镜诊治临床分析

目的探讨盆腔粘连与女性不孕症的关系，以及腹腔镜在诊治盆腔粘连相关的女性不孕症中的意义。方法回顾性分析2003年6月至2005年6月在我院因不孕症行腹腔镜诊治的481例不孕患者。其中原发不孕175例，继发不孕306例。分析腹腔镜下不孕症患者盆腔粘连、盆腔粘连合并输卵管阻塞发生率和盆腔粘连腹腔镜术后妊娠情况。结果腹腔镜检查发现原发和继发不孕患者盆腔粘连发生率分别为45．7％和65％，差异有显著性（P〈0．05）。盆腔粘连合并输卵管阻塞在原发不孕中发生率为65．0％，在继发不孕中发生率为58．7％。原发不孕盆腔粘连患者腹腔镜术后宫内自然妊娠率为32．5％（26／80），其中术后6个月内自然妊娠占76，9％（20／26）；继发不孕盆腔粘连患者腹腔镜术后宫内自然妊娠率为27.1％（54／199），其中术后6个月内自然妊娠占66．7％（36／54）。结论盆腔粘连是引起女性不孕症最常见盆腔病变之一。腹腔镜可及时准确地发现不孕症患者的盆腔粘连情况，并同时行镜下盆腔粘连的分离，是诊治不孕患者较为理想的方法。

Clinical analysis of the diagnosis and treatment of pelvic adhesion in women with infertility by laparoscopic operation

Objectives To investigate the relationship between pelvic adhesion and female infertility,and to evaluate laparoscopic operation in diagnosis and treatment of infertility in women.Methods Retrospective analysis of 481 cases of infertility,which involved with laparoscopic operation from June 2003 to June 2005,was carried out,including 175 cases of primary infertility and 306 secondary ones.The incidence of pelvic adhesion,complications of salpingemphraxis,postoperative reproductive outcomes were assessed.Results Adhesion of the pelvic cavity was found in 65% of the women with secondary infertility and 45.7% of primary infertility(P<0.05).Pelvic adhesion complicated with salpingemphraxis was observed in 58.7% of the patients with secondary infertility,65.0% in patients with primary infertility.Spontaneous pregnancy rate was 32.5%(26/80)in patients with primary infertility and pelvic adhesion treated with laparoscopic operation,76.9%(20/26)of which occurred within 6 months.In the secondary infertility group,spontaneous pregnancy rate was 27.1%(54/199),66.7%(36/54)of which happened within 6 months.Conclusions Adhesion in pelvic cavity is the most common cause for female infertility,especially for those with secondary infertility,which mainly causes dysfunction of the fallopian tubes.Laparoscopic operation is valuable in diagnosis the adhesion accurately and timely,as well as in separation the adhesion,reshaping the related structure,etc.Therefore,laparoscopic operation is one of the optimal methods in diagnosis and treatment of female infertility.