经宫颈感染细菌及沙眼衣原体所致不孕的临床观察

目的 比较盆腔细菌、沙眼衣原体感染所致不孕症的临床特征及腹腔镜下特点。方法 随机选择盆腔细菌、沙眼衣 原体感染所致不孕症各５０例，进行临床观察和腹腔镜检查。结果盆腔细菌感染组中有宫腔操作史、急性盆腔炎史、下 腹痛史依次为２４.４％、４３．３％、７８.６％，盆腔沙眼衣原体感染组中则分别为６．２％、８．９％和３７．５％（P＜０.０５）。腹腔镜检中，盆 腔细菌感染组中引起盆腔粘连、输卵管肿胀或积水、输卵管不全堵塞分别为３５．７％、１４．４％、１７．４％，盆腔沙眼衣原体感染 组发生盆腔粘连１４．２％、输卵管肿胀或积水２７．９％、输卵管不全堵塞３９．６％（Ｐ＜０．０５）。盆腔细菌感染组中原发性不孕为 ３０．３％、继发性不孕为６９.７％（Ｐ＜０．０５），盆腔沙眼衣原体感染组中分别为５２．７％和４７．３％。结论盆腔细菌感染临床表现 较为典型，常有宫腔操作史、急性盆腔炎史、明显下腹痛，腹腔镜下主要表现为盆腔粘连、输卵管损伤；盆腔沙眼衣原体 感染临床表现不典型，腹腔镜下主要表现为输卵管损伤，不易早期诊治，并均可导致不孕。

Clinical observation of infertility caused by pelvic bacterial or Chlamydial trachomatis infection

Objective To investigate the different clinical and laparoscopic characteristics of infertility caused by pelvic bacterial infection in comparison with that caused by Chlamydial trachomatis. Methods Infertile patients with pelvic bacterial infection or with Chlamydial tracholnatis infection were enrolled in this study, and in each group, 50 subjects were randomly selected for clinical observation and laparoscopic examination. Results In the infertile patients with pelvic bacterial infection, 24.4% had a history of uterine problems that required intra-uterine operation, and 43.3% and 78.6% experienced pelvic inflammatory diseases and lower abdominal pain respectively; these 3 problems, in contrast, were found to occur in 6.2%, 8.9% and 37.5% infertile patients with Chlamydial trachomatis infection, respectively (P<0.05). Laparoscopically, 35.7%, 14.4% and 17.4% bacterium-infected patients suffered pelvic adhesion, oviductal swelling or hydrosalpinx, and partial obstruction of the oviducts, respectively, which compromised 14.2%, 27.9% and 39.6% patients with Chlamydial trachomatis infection (P<0.05). In terms of primary and secondary infertility, the occurrence rates were30.3% and69.7% in bacterium-infected group vs 52.7% and 47.3% in the other (P<0.05). Conclusions The clinical manifestations of pelvic bacterial infection are typical with a history of intra-oviductal operation, episodes of acute pelvic inflammation and lower abdominal pain, laparoscopic examination reveals pelvic adhesion and oviductal damages. Pelvic infection with chlamydial trachomatis does not present typical features and laparoscopically shows oviductal lesions, liable to result in infertility, and its diagnosis and early treatment are difficult.