腹腔镜下盆腔粘连松解治疗不孕症226例临床观察

目的探讨腹腔镜下盆腔粘连松解治疗不孕症的安全性和有效性。方法自2006年2月-2008年12月,对226例患者在本院用腹腔镜行盆腔粘连松解。记录盆腔粘连与松解情况、输卵管通畅性及术后妊娠情况。结果①腹腔镜下盆腔粘连松解,共松解430条输卵管(22例单侧输卵管已部分切除),其中14例卵巢处粘连未能完全松解暴露卵巢,能大部分显露于外,余盆腔粘连完全松解。②输卵管染色通液中发现42条近端梗阻(含22例单侧输卵管已部分切除),2条输卵管部分疏通。③术后无并发症发生,72-96小时出院。④妊娠率:术后随访13-23个月,妊娠率为41.96%(94/224),2例失访。一侧输卵管与双侧输卵管远端部分梗阻的两个组治疗后受孕率比较,其差别无显著意义(P0.05),与双侧输卵管远端完全梗阻治疗后受孕率比较,其差别有显著意义(P0.01);轻度盆腔粘连与中度盆腔粘连两个组治疗后受孕率比较,其差别无显著意义(P0.05),与重度盆腔粘连治疗后受孕率比较,其差别有显著意义(P0.01)。结论腹腔镜下盆腔粘连松解治疗不孕症可行,有效。适用于输卵管碘油造影(HSG)检查:输卵管积水、轻度盆腔粘连,特别是输卵管远端部分梗阻的治疗。

Study on hydrolaparoeacopic pelvic adhesiolysis in the infertile woman

【Objective】To investigate the safety and efficacy of hydrolaparoscopic pelvic adhesiolysis in the infertile women.【Methods】From February 2006 to December 2008,226 infertile patients underwent hydrolaparoscopic pelvic adhesiolysis.The adhesions were graded as mild ﹑ moderate and severe.The diuation of the operation and discharge,pelvic adhesions scare,Tubal patency,complications and pregrancy rate were investigated.【Results】① Hydrolaparoscopic pelvic adhesiolysis：there were 430 fallopian tubers（22 fallopian tubers had been ablated） have been discharged,The majority of pelvic adhesions in all patiens were successfully performed adhesiolysis,only alittly filmy adhesions of 14 Ovaries.② Fallopian tubal patency：42 fallopian tubes were of proximal occlusion by dyetest（contain 22 single already part of excisions of side fallopian tube）,2 fallopian tube abstruction part to dredge.③ The duration of be hospitalized 72-96 hours,No complications occurred.④The rate of pregrancy：in the 13-23 months＇ follow-up,The rate of pregrancy was 41.96%（94 /224）,Which one patient lost follow-up.There was no diffrence between both sides of fallopian tube distant part complete block had be treated（P〈 0.01） with other two groups;The rate of pregrancy which severe pelvic adhesions had be treated lower（P〈 0.01） compared with other two groups.【Conclusion】Hydrolaparoscopic pelvic adhesiolysis is safe ﹑ efficacious.Be applicable to the HSG test：accumulates the water、mild-pelvic adhesions,Especially for fallopian tubes were of distant segment occlution partly.