宫腹腔镜联合手术诊治不孕症120例分析

目的探讨宫、腹腔镜联合手术在女性不孕症诊治中的应用优势。方法联合应用宫、腹腔镜对120例不孕症患者进行检查,并对病因明确者行相应治疗。结果盆腔粘连和输卵管阻塞是造成妇女不孕的主要原因。子宫内膜异位症和卵巢疾病也是常见因素。术后妊娠率达43．8％。结论应用宫、腹腔镜联合诊治不孕症患者能直观、准确、全面地明确盆腔、官腔疾患,并予以针对性治疗,提高手术疏通输卵管的成功率,提高女性不孕患者的妊娠率。     

腹腔镜手术联合中药灌肠和理疗治疗不孕症的临床观察

目的探讨腹腔镜下输卵管整复术后联合中药灌肠和物理治疗,治疗输卵管性不孕症的效果。方法对输卵管性不孕患者,在腹腔镜下行盆腔粘连分离、伞端成形或输卵管造口术、输卵管间质部梗阻插管疏通术,术后自然周期观察6个月未孕者,均给予促排卵治疗,卵泡成熟后根据排卵期宫颈粘液情况指导同房或行宫腔内人工授精,继续观察至术后一年,观察组另联合中药灌肠和物理治疗。结果观察组妊娠率33.73%,对照组妊娠率23.08%。结论在腹腔镜手术分离粘连、恢复盆腔正常解剖结构术后,联合中药保留灌肠和盆腔理疗,能提高妊娠率。     

介入术输卵管再通临床应用体会

目的回顾122例已婚不孕妇女行介入术输卵管再通后的临床疗效分析,评价其在治疗输卵管阻塞所致不孕症的应用价值。方法122例不孕症患者均在X线床上取截石位,在电视透视下将导管送入阻塞部位,经造影后行再通治疗,以造影剂进入盆腔证明阻塞段再通。结果122例220条不通输卵管中,行再通术后175条通畅度明显改善,盆腔内造影剂弥散总有效率为79.5%,经再通术后八个月随访观察,有39例发生妊娠,妊娠率占30.5%.因术后不孕复查发生再粘连者31例,占17.7%,其中结核5例10条,伞部重度积水8条.结论选择性输卵管造影再通术是目前诊断和治疗输卵管阻塞所致不孕症最简便、安全、无创伤,经济有效的方法。     

卵巢病变导致不孕的腹腔镜诊治

目的 探讨腹腔镜治疗卵巢病变导致不孕的疗效.方法 对43例排卵异常的不孕症采用腹腔镜治疗术后排卵、妊娠、流产情况.结果 术后35例正常排卵,26例妊娠,5例早期流产,8例仍不排卵.结论 腹腔镜能够明确诊断部分通过常规的检查手段难以发现的导致不孕的卵巢病变,同时实施手术,恢复正常排卵,并同时松解输卵管伞端与卵巢的粘连,解决排卵不畅和输卵管拾卵功能差的问题,使不孕症病人的治疗途径不断拓宽、有效.     

腹腔镜与宫腔镜联合治疗不孕不育症18例临床观察

目的通过宫腔镜、腹腔镜检查,探讨引起不孕症的原因,以及在女性不孕症诊治中的应用。方法对18例不孕妇女进行宫腔镜和腹腔镜检查,并予以相应治疗。结果术后6个月内妊娠6例,占33%;术后1年内妊娠（含6个月内）妊娠8例,占44%。结论宫腔、腹腔炎症与不孕症有关,宫腔粘连、输卵管阻塞等仍为不孕症的主要原因,宫腔镜和腹腔镜的联合应用对不孕症患者的诊治效果非常理想。     

腹腔镜用于诊治女性不孕症的临床应用

目的：探讨腹腔镜在诊治不孕症中的应用。方法对78例不孕症患者行腹腔镜检查术,对不孕病因进行诊断,同时根据所查病因在腹腔镜下作出相应的手术治疗。结果盆腔粘连,输卵管阻塞,子宫内膜异位症和多囊卵巢综合征是引起女性不孕症的主要盆腔疾患。78例均行腹腔镜下输卵管通液和各种疾病的治疗。结论腹腔镜技术能早期、迅速明确不孕症输卵管及盆、腹腔病因,融诊断、治疗于一体,具有创伤小、出血少、康复快等优点,增加术后妊娠率,避免了治疗中的盲目性。     

腹腔镜输卵管修复整形术治疗输卵管积水性不孕效果分析

目的：探讨腹腔镜输卵管修复整形术治疗输卵管积水性不孕的临床疗效。方法回顾分析采用腹腔镜输卵管修复整形术治疗的118例输卵管积水性不孕症患者的临床资料,观察和比较不同积水程度患者的疗效。结果本组术后共27例(22.88%)成功妊娠,其中,输卵管积水高评分组14例(46.67%),中评分组10例(16.67%),低评分组3例(10.71%),高评分组的妊娠率显著高于中、低评分组(P<0.05);高评分组的复发率显著低于中、低评分组(P<0.05)。结论腹腔镜输卵管修复整形术治疗输卵管积水性不孕尤其是输卵管积水高评分者疗效显著,但仍存在一定的复发率,且妊娠率较低,建议对输卵管积水中低评分者实施患侧输卵管切除术,以降低复发率、提高妊娠率。     

中西药结合治疗综合因素不孕症65例分析

目的　探讨综合性因素不孕症的中西医结合治疗方法。方法　针对不同不孕因素选用中西药配合治疗 ,对于男方精液欠佳者用西药治疗的基础上用强肾胶囊治疗 3个月 ;女方输卵管粘连者则通液术 ,腹腔镜下分离术 ,结合中药活血化瘀药物治疗 ;排卵功能欠佳者在用克罗米芬促排卵改善黄体功能基础上加用药人工周期法。结果　 6 5例综合因素不孕病人治疗 1～ 6周期 ,妊娠 5 8例 ,妊娠率达 89 2 3%。结论　中西医结合治疗综合因素不孕症具有显著疗效 ,其治疗的先决条件是对不孕症病人全面检查 ,针对病因予以治疗     

腹腔镜手术对输卵管妊娠患者术后生育结局的影响

目的探讨腹腔镜下不同术式对输卵管妊娠患者术后生育结局的影响。方法回顾分析了86例经腹腔镜手术及70例开腹手术的输卵管妊娠患者术后不孕、异位妊娠及宫内妊娠的发生率。结果经腹腔镜手术的患者术后宫内妊娠率50％高于行开腹手术者35．7％（P〈0.05）；在不同的腹腔镜术式中，行输卵管保守性手术的患者术后宫内妊娠率52．8％高于行患侧输卵管切除术者35．7％（P〈0.05）；在行保守性手术中，壶腹部妊娠及伞端妊娠患者术后宫内妊娠率分别为60％及61．1％，均高于峡部妊娠者31.6％（P〈0．05）。结论腹腔镜手术有利于改善输卵管妊娠患者术后生育结局，壶腹部妊娠及伞端妊娠患者宜行输卵管保守性手术。     

腹腔镜在治疗输卵管、卵巢性不孕症诊治中的应用

目的:探讨腹腔镜在输卵管、卵巢性不孕症治疗中的疗效及影响因素.方法:对35例不孕症患者行腹腔镜诊疗,其中原发性不孕症11例、继发性不孕症24例.结果:35例手术均顺利,无并发症.术后29例获随访,随访3～18个月,术后宫内妊娠率达37.93%(11/29).结论:腹腔镜手术对输卵管远端阻塞、盆腔粘连及肿块导致输卵管扭曲的不孕症有良好的治疗效果,对不明原因的不孕症能尽早明确诊断.     

Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechialysis.

Twelve consecutive patients with total corporal synechiae due to tuberculosis were reviewed in terms of intrauterine adhesion re-formation rate following hysteroscopic surgery. All patients presented with secondary amenorrhoea and infertility. The diagnosis was based on a 'glove finger appearance' at hysterosalpingography and classical laparoscopic and tubal biopsy findings. Intrauterine synechiae re-formation was assessed by postoperative hysterosalpingograms performed 3-4 months after the procedure. The 12 patients underwent 15 attempts for hysteroscopic lysis of total corporal synechiae. Three perforations occurred and all were managed with laparoscopic extracorporal suturing. Ultimately, adequate uterine cavity was obtained in all cases. Total intracorporal synechiae recurred in all patients at control postoperative hysterosalpingograms. We conclude that total corporal synechiae caused by tuberculosis, unlike other causes, carry a poor prognosis following hysteroscopic lysis. Surrogacy may be the only option for fertility in such couples.     

The prognostic role of salpingoscopy in laparoscopic tubal surgery

The present study was designed to evaluate the prognostic value of salpingoscopy in patients undergoing tubal laparoscopic surgery for infertility due to periadnexal adhesion or distal tubal occlusion. In addition, the clinical value of salpingoscopy was compared with a current classification system of adnexal adhesions and distal tubal occlusion. A total of 51 patients with either adnexal adhesions (24 patients) or hydrosalpinx (27 patients) were prospectively evaluated. Salpingoscopy was performed concomitantly with salpingo-ovariolysis or salpingoneostomy at the time of operative laparoscopy. There was no significant correlation between salpingoscopic classes and the classification system used for both the salpingo-ovariolysis and the salpingoneostomy groups of patients. The patients had a mean follow-up of 33 months. Patients with a normal tubal mucosa (salpingoscopic classes I and II) had a 71% cumulative term pregnancy rate in the salpingo-ovariolysis group and a 64% cumulative term pregnancy rate in the salpingoneostomy group. No intrauterine pregnancies were obtained in patients with intratubal damage (salpingoscopic classes III to V). There was a statistically significant correlation between the occurrence of a term pregnancy and the salpingoscopic classes, but not with the classification system used. These results suggest that patients with tubal infertility should be offered operative laparoscopy with salpingoscopy as the first step of treatment.     

腹腔镜诊治不孕症患者盆腔病变临床分析

目的探讨应用腹腔镜手术诊治不孕症的临床价值。方法对126例女性不孕症患者行腹腔镜诊断和治疗,观察术后妊娠率。结果 126例中发现盆腔病变117例,占92.86%;慢性盆腔炎是不孕症的第1位病因;其次为子宫内膜异位症、多囊卵巢综合征。腹腔镜手术术后妊娠率为47.50%,1例发生异位妊娠。结论腹腔镜手术对女性不孕症盆腔病变的诊治具有重要的价值。     

Assessment of tubal patency with transvaginal salpingosonography after treatment for tubal pregnancy

Tubal patency was studied in 32 patients who had previously undergone a laparoscopic or laparotomy procedure (salpingostomy, salpingectomy or tubal resection), or who had received a local injection of hypertonic glucose because of tubal pregnancy. Transvaginal salpingosonography (TSSG) was subsequently performed in the follicular phase of the menstrual cycle, and laparoscopic chromopertubation was carried out as a comparative method after TSSG. Of 32 patients (47 Fallopian tubes examined), the affected tube was observed to be patent by TSSG in 68%. The contralateral tube was patent in 93%. Nine patients became pregnant and were thus not subsequently assessed with laparoscopy. Two of these pregnancies ended in a miscarriage and one in a recurrent tubal pregnancy. A concordance of 86% for Fallopian tubes was achieved between the TSSG and laparoscopic chromopertubation methods. When checking the Fallopian tubes separately, the concordance for the results in the affected tubes was 67%, and 100% for the contralateral tube. Therefore TSSG appears to be a practical method for the primary examination of tubal patency in patients treated previously for tubal pregnancy. Guidelines for the treatment of infertility after tubal pregnancy can also be set out according to TSSG findings.      

自然周期IVF／IVM技术治疗输卯管因素和男性不育患者的临床疗效分析

目的比较自然周期IVF结合未成熟卵母细胞IVM（自然周期IVF／IVM）治疗输卵管因素不育、男性不育和输卵管／男性混合不育的临床疗效,进一步确立自然周期IVF／IVM技术在不孕症治疗中的临床价值。方法回顾性分析自然周期IVF／IVM536个取卵周期,将输卵管因素不育（T）、男性不育（MF）和输卵管／男性混合不育（T／MF）患的临床结局进行详细比较．结果209例输卵管因素不孕患者开始248个周期,完成245个移植周期;142例男性不育患者开始164个周期,完成160个移植周期;53例输卵管／男性因素混合不孕患者开始并完成53个移植周期。三组之间均获卵数在9．8±5．3（T／MF组）至10．9±5．3（T组）之间,无显著差异,受精率和卵裂率均无显著差异。T、MF和T／MF三组之间的的临床妊娠率（分别为31．4％、36．3％和35．3％）、胚胎着床率和流产率均无显著差异。结论从本研究可以看出,自然周期IVF／IVM用于临床妊娠率输卵管因素不育、男性不育和输卵管／男性混合不育的治疗,可以获得较好的临床结局。     

Salpingectomy or proximal tubal occlusion of unilateral hydrosalpinx increases the potential for spontaneous pregnancy

BACKGROUND: Studies carried out over the past 10 years have suggested that hydrosalpinges reduce the pregnancy rate in IVF. Here we report our observations of spontaneous pregnancies in patients who underwent salpingectomy (n = 18) or proximal tubal occlusion (n = 7) following diagnoses of unilateral hydrosalpinges and patent contralateral tubes. METHODS: This multi-centre, retrospective study included 25 infertility patients with known unilateral hydrosalpinges with a patent contralateral Fallopian tube. Laparoscopic treatment of unilateral hydrosalpinges by either salpingectomy or tubal occlusion was performed in each patient. Rates of subsequently observed spontaneous pregnancy, and time to pregnancy, are reported. RESULTS: The average duration of infertility in these patients was 3 years with a range of 1-10 years. Following laparoscopic surgical treatment, a total of 22 patients (88%) achieved intrauterine pregnancies, all without IVF treatment. Pregnancies occurred in an average of 5.6 months with a range of 1-21 months. There were no ectopic pregnancies in the study population. CONCLUSIONS: Selected patients with unilateral hydrosalpinges and a patent contralateral Fallopian tube may exhibit increased cycle fecundity after salpingectomy or proximal tubal occlusion of the affected tube and conceive without the need for IVF.     

Recurrent heterotopic pregnancy after repeated in-vitro fertilization treatment

We report a rare clinical case of recurrent heterotopic pregnancy in the same patient following in-vitro fertilization treatments. A 27 year old woman, who suffered from infertility for the last 4 years due to male factor, was being treated by intracytoplasmic sperm injection which resulted in two episodes of combined intrauterine and tubal pregnancy, in a 1 year period. The first ended in emergency salpingectomy by laparotomy and missed intrauterine abortion. The second was managed by laparoscopic salpingectomy and the synchronous pregnancy ended in the delivery of twins. The possibility of heterotopic pregnancy and recurrent heterotopic pregnancy, though rare, should be considered by every gynaecologist, especially those who use infertility treatment on patients.      

Transcervical falloscopic dilatation of proximal tubal occlusion. Is there an indication?

Proximal tubal occlusion (PTO), until recently a domain of microsurgery, can also be treated by a transcervical balloon dilatation and/or tubal recanalization. The aim of our study was to evaluate the possibility of transcervical tubal dilatation during transcervical Falloposcopy. Transcervical Falloposcopy and tubal dilatation was performed under laparoscopic control. During a period of 48 months a total of 157 Falloposcopies was performed. Out of a total of 157 patients, 42 patients had PTO confirmed by dye-pertubation during laparoscopy. All patients were referred because of primary or secondary tubal infertility. A total of 18 patients had bilateral PTO by dye-pertubation and of these six patients had successful bilateral and seven patients successful unilateral recanalization. The remaining five patients were unable to recanalize. A total of 24 patients had an unilateral PTO by dye-pertubation, 13 of these patients had a contralateral diseased tube, seven of which could be recanalized. Four patients had contralateral normal tubes, with successful recanalization in one patient. Seven patients had an occluded or missing contralateral tube, five of which could be recanalized. A total of 60 tubes with PTO were diagnosed, of which 32 (53.3%) tubes could be recanalized. 20 of these had normal tubes. Only patients with healthy Fallopian tubes carried pregnancies to term (five pregnancies, 12% of all patients). All patients conceived within a period of 3-6 months. We observed no ectopic pregnancy.     

腹腔镜下输卵管切开取胚联合输卵管通液术对远期妊娠的影响

目的 探讨异位妊娠患者腹腔镜下行输卵管切开取胚术联合输卵管通液术对远期妊娠结局的影响。方法 选择2015年1月~2016年7月在我院妇科治疗的输卵管妊娠患者138例,依据手术方式不同分为实验组70例和对照组68例,实验组行腹腔镜下患侧输卵管切开取胚术及子宫输卵管通液术,对照组单纯行患侧输卵管切开取胚术,比较两组手术时间、术中出血量、术后排气时间、住院天数,及术后2年内妊娠情况。结果 两组患者术中出血量,手术时间、术后排气时间、住院天数比较,差异无统计学意义（P＞0.05）。实验组术后2年内再次异位妊娠率为4.23%,3例再次异位妊娠再次行腹腔镜手术,46例宫内妊娠,8例继发性不孕,6例失访。对照组的再次异位妊娠率为16.18%,11例再次异位妊娠再次行腹腔镜手术,30例宫内妊娠,13例继发性不孕,7例失访。实验组的再次异位妊娠率低于对照组,再次宫内妊娠率高于对照组,差异有统计学意义（P＜0.05）。结论 腹腔镜下切开取胚术联合输卵管通液术可同时在术中判断对健侧输卵管通畅度,还可指导通而不畅甚至堵塞输卵管术中同时治疗,可能有助于降低再次异位妊娠的概率。     

Controversies and problems in the current management of tubal pregnancy

The two main conservative treatment alternatives for tubal pregnancy,methotrexate administration and laparoscopic salpingostomy areunder constant review. Recently, expectant management of tubalpregnancy has become increasingly popular. In this review, weassess the outcome of conservative management modalities fortreatment with methotrexate and operative laparoscopy. Outcomesof extrauterine pregnancy were obtained from a review compiledfrom the English literature identified by directed Medline search.Methotrexate and laparoscopic salpingostomies yield good finaltreatment rates of 85-95% respectively and relatively low ratesfor further surgical complication (5-10% respectively). Tubalpatency, as well as future fertility performance, are quitesimilar after both techniques. Although they appear to suitthe demands of the 21st century, each one has its own benefitsand contraindications. With adequate patient selection, expectantmanagement of the tubal pregnancy is a reasonable approach withgood results. Although the morbidity rate after tubal pregnancytreatment is decreasing and the main concern is to reduce thedecline in fertility potential, the real future challenge remainsprevention of the disease, especially among the high risk patients,such as those undergoing infertility treatment. Keywords: assisted reproductive techniques/conservative treatment/methotrexate/operativelaparoscopy/tubal pregnancy