联合宫、腹腔镜对宫腔内人工授精失败患者的再评价

目的 探讨联合宫、腹腔镜对宫腔内人工授精（IUI）失败的不孕患者进行再评价，分析其临床特点，了解术后获得妊娠的时间分布特点。方法 收集自1994年1月-2004年4月在深圳市妇幼保健院因IUI失败的不孕患者21例，先后或同时行宫、腹腔镜联合检查，对其临床特点及其手术后妊娠率及术后获得妊娠时间分布特点进行回顾性分析。结果 慢性盆腔炎症及子宫内膜异位症（57％）是引起IUI失败的不孕患者的主要盆腔病变；子宫内膜炎、子宫黏膜下肌瘤、子宫内膜息肉是IUI失败的不孕患者的主要宫腔病变。IUI失败的不孕患者宫、腹腔镜手术治疗后的妊娠率为47．6％（10／21），术后18个月内获得妊娠者占90％。结论 在IUI失败的不孕患者病因诊断中，宫、腹腔镜联合检查明显优于单独的宫腔镜或腹腔镜检查，宫、腹腔镜联合可以手术矫治可逆的输卵管及宫腔病变，提高IUI治疗的成功率。

Laparoscopy combined with hysteroscopy applied to evaluate the infertile women after intrauterine insemination failure

[Objective] To evaluate the usage combining laparoscopy and hysteroscopy in the patients after intrauterine insemination failure. [Method] From Jan 1994 to Apr 2004, 21 patients who failed to conceive after intrauterine insemination were investigated and treated by laparoscopy and hysteroscopy. All the patients were underwent the hysteroscopy and laparoscopy evaluation at the same time or successively. [Result] By the diagnostic laparoscopy, the pelvic abnormalities included pelvic inflammatory disease and endometriosis(57%). By the diagnostic hysteroscopy, the intrauterine abnormalities included endometritis, submucous myomas, polypus. The cumulative pregnancy rate was 47.6%. Among all the followed up patients, 90% of women became pregnent within 18 months after operation. [Conclusion] This study demonstrates that combination of laparoscopy and hysteroscopy was superior to laparoscopy alone and hysteroscopy alone in the treatment of patients after intrauterine insemination failure, which can improve the chance of pregnancy in IUI.