子宫输卵管碘油造影联合宫、腹腔镜手术诊治输卵管性不孕症118例临床分析

目的探讨子宫输卯管碘油造影联合宫、腹腔镜手术诊治输卵管不孕症的临床疗效。方法对本院2009年3月～2012年3月的子宫输卵管碘油造影诊断输卵管性不孕118例患者共236条输卵管行宫、腹腔镜诊治，行盆腔粘连松解术、输卵管伞端闭锁造口及成形术、输卵管插管加压通液术等。结果118例患者在腹腔镜直视下常规行子宫输卵管通液显示：双侧输卵管通畅14例，占11．86％（28／236），一侧输卵管通畅20例，占8．47％（20／236），输卵管近端阻塞（间质部、峡部阻塞）51例，占38．98％（92／236），输卵管远端阻塞（壶腹部及输卵管积水）53例，占40．68％（96／236）。子宫输卵管碘油造影与宫、腹腔镜诊断输卵管阻塞符合率为79．66％（188／236）。宫、腹腔镜下对92条输卵管近端阻塞行输卵管插管，术后重新疏通78条，失败14条。腹腔镜下对输卵管积水行分离、壶腹部扩张、造口术32条。术后随访106例6～36个月，宫内妊娠48例，异位妊娠10例。结论子宫输卵管碘油造影联合宫、腹腔镜手术对诊治输卵管性不孕症不仅能够准确判定输卵管的阻塞部位、提高了诊断符合率而且可以提高患者的输卵管疏通率及受孕率。

Hysterosalpingography combined with hysteroscopic and laparoscopic surgery for treatment of tubal Infertility

Objective To discuss clinical effects of hysterosalpingography combined with hysteroscopic and laparo- scopic surgery for treatment of tubal infertility. Methods Two hundred and thirty-six oviducts of 118 patients diag- nosed with tubal infertility by hysterosalpingography in our hospital from March 2009 to March 2012 were given hys- teroscopie and laparoscopic diagnosis and treatment, such as the pelvic adhesions lysis, tubal distal occlusion stoma and angioplasty, tubal cannulation and pressure hydrotubator surgery. Results Under peritoneoscopy, 118 patients were given routine uterine and tubal hydrotubator surgery, the results showed bilateral tubal patency in 14 cases, accounting for 11.86% （28/236）, side of tubal patency in 20 cases, accounting for 8.47% （20/236）, proximal tubal occlusion （in- terstitial portion of the isthmus obstruction） 51 cases, accounting for 38.98% （92/236）, distal tubal occlusion （tubal am- pulla ponding and hydrosalpinx） in 53 cases, accounting for 40.68% （96/236）. Accordance rate between hysterosalpin- gography and hysteroseopic and laparoseopic surgery were 79.66% （188/236）. 92 oviducts with proximal tubal occlusion were given tubal cannulation under hysteroscopic and laparoscopic surgery, 78 cases of them were re-dredged after surgery and 14 failed to re-dredge. Laparoscopic hydrosalpinx separation and ampullary dilatation and ostomy were made in 32 oviducts. 106 cases were followed up by 6 to 36 months with intrauterine pregnancy in 48 cases and 10 cases of ectopic pregnancy. Conclusion Hysterosalpingography combined with hysteroscopic and laparoscopic surgery for treatment of tubal infertility can not only accurately detex~nine the tubal obstruction site and improve diagnosis rate, but also can improve the patient＇s fallopian tube dredge rate and pregnancy rate.