Tolterodine reduces the number of urge incontinence episodes in patients with an overactive bladder

OBJECTIVE: To evaluate the feasability of transvaginal hydrolaparoscopy in infertile patients undergoing basic infertility investigations, and to determine its usefulness in comparison with standard laparoscopy. MATERIALS AND METHODS: Twenty-three unexplained infertile women were prospectively included. Selected patients had no history of pelvic disease or previous pelvic surgery and had normal findings on gynecological examination and vaginal sonography. The patients received general anesthesia and underwent the transvaginal hydrolaparoscopy immediately prior to a standard laparoscopy by a different operator. The main outcome measures were the rate of successful access to the pouch of Douglas, the duration of the procedure, and the rate of complications. In order to compare the accuracy of the transvaginal hydrolaparoscopy to the standard laparoscopy, findings in terms of tubal pathology, endometriosis, and adhesions were analyzed. RESULTS: The successful rate of access to the pouch of Douglas was 95.7%. The rate of complications was 4.3%. The mean duration of the transvaginal hydrolaparoscopy procedure was 8 min. The concordance between transvaginal hydrolaparoscopy and laparoscopy for pelvic cavity examination was statistically significant (k=0.57, P=0.02). In 40.9% of cases, the transvaginal hydrolaparoscopy procedure has shown a normal pelvic examination confirmed by laparoscopic diagnosis. According to the findings by laparoscopy, transvaginal hydrolaparoscopic diagnosis was correlated well in 81.8% of cases. When transvaginal hydrolaparoscopy showed pathological findings, there were no normal laparoscopies. Pathological laparoscopies were found in 18.2% of the normal transvaginal hydrolaparoscopies. CONCLUSION: The transvaginal hydrolaparoscopy is a reproducible and safe method to investigate the pelvis and its structures. The diagnostic accuracy of the transvaginal hydrolaparoscopy suggests that more than 40% of standard laparoscopies for unexplained infertility could be avoided.     

生育镜在不孕症诊治中的应用

目的探讨生育镜用于不孕症诊治的价值。方法用生育镜[包括经阴道注水腹腔镜（THL）与宫腔镜]对115例不孕症患者进行盆腔检查,观察内容包括输卵管通畅性、盆腔粘连情况等,以及盆腔完全评价率（即盆腔器官是否能被生育镜全部观察到）及术中、术后并发症。同时行THL下输卵管通液术和宫腔镜下输卵管口插管通液术。穿刺套管针成功从后穹窿穿刺入子宫直肠陷凹110例,其中原发性不孕（原发组）49例,继发性不孕（继发组）61例。既往输卵管检查为双侧阻塞者,原发组21例,继发组22例。结果术后输卵管双侧或一侧通畅者原发组34例（69．4％,34／49）,继发组42例（68．9％,42／61）,两组比较,差异也无统计学意义（P〉0．05）;既往输卵管检查为双侧阻塞者,术后双侧或一侧输卵管通畅者原发组10例（47．6％,10／21）,继发组11例（50．0％,11／22）,两组比较,差异无统计学意义（P〉0．05）。盆腔粘连者原发组21例（42．9％,21／49）,继发组37例（60．7％,37／61）,两组比较,差异无统计学意义（P〉0．05）。两组总的盆腔完全评价率为69．1％（76／110）,其中原发组为77．6％（38／49）,继发组为62．3％（38／61）．两组比较,差异无统计学意义（P〉0．05）。术后需行常规腹腔镜手术者20例（18．2％,20／110）,原发组与继发组分别为4例（8．2％,4／49）和16例（26．2％,16／61）,两组比较,差异有统计学意义（P〈0．05）;其中17例接受了微型腹腔镜手术。术中无盆腔脏器损伤、出血、直肠损伤或穿孔,术后无穿刺部位出血及盆腔感染等并发症发生。结论生育镜用于不孕症的诊治,操作简单、微创、安全、患者依从性好;对于临床或超声检查均无明显盆腔疾病证据的不孕症患者,生育镜可以取代经腹腹腔镜,成为一步到位的盆腔检查方法。     

Transvaginal hydrolaparoscopy and laparoscopy

Research questionTo evaluate the findings of outpatient transvaginal hydrolaparoscopy (THL) in comparison with diagnostic laparoscopy combined with chromopertubation in subfertile women.DesignIn a retrospective study in four large teaching hospitals, all subfertile women who underwent a THL and a conventional laparoscopy as part of their fertility work-up in the period between 2000 and 2011 were studied. Findings at THL were compared with findings at diagnostic and therapeutic laparoscopies. Tubal occlusion, endometriosis and adhesions were defined as abnormalities.ResultsOut of 1119 women, 1103 women underwent THL. A complete evaluation or incomplete but diagnostic procedure could be performed in 989 (89.7%) and 28 (2.5%), respectively. An incomplete non-diagnostic procedure was performed in 11 (1.0%) women. Failure of THL occurred in 75 women (6.8%) and 40 of these women (3.6%) subsequently underwent laparoscopy. Laparoscopy was performed in a total of 126 patients with a median time interval of 7 weeks (interquartile range [IQR] 3–13 weeks). Of 64 patients who successfully underwent both THL and laparoscopy, concordant findings were found in 53 women and discordant results in 11 women, 6 of which were caused by tubal spasm. Sensitivity of THL in detecting abnormalities was 100% and specificity was 22.2%, with a likelihood ratio of 1.29.ConclusionTHL in an outpatient setting can detect anatomical abnormalities comparable to the more invasive reference standard diagnostic laparoscopy. If THL succeeds, there is no need to add a diagnostic laparoscopy in the work-up.     

Tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy and minihysteroscopy) versus hysterosalpingography in an outpatient infertility investigation.

OBJECTIVE: To compare the acceptance and tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy [THL] combined with minihysteroscopy) versus hysterosalpingography (HSG) for evaluating tubal patency and the uterine cavity in an outpatient infertility investigation. DESIGN: Randomized controlled study. SETTING: University hospital. PATIENT(S): Twenty-three infertile patients without obvious pelvic pathology. INTERVENTION(S): Women were randomly divided into two groups. One group underwent minihysteroscopy and THL with tube chromoperturbation as first investigation and HSG within the following 7 days, while in the other group the investigation sequence was inverted. Women reported pain experienced before and at the end of procedures. MAIN OUTCOME MEASURE(S): Mean duration of procedures, level of pain experienced, diagnostic agreement about tubal patency and uterine cavity normality. RESULT(S): THL and minihysteroscopy took significantly more time but was significantly less painful than HSG. Regarding tubal patency, in 95.5% of cases THL agreed with HSG. In one case, HSG diagnosed a bilateral obstruction of tubes, whereas at THL a bilateral spreading of methylene blue was seen. Agreement on intrauterine pathologies between minihysteroscopy and HSG was poor (43%); the number of intrauterine abnormalities found at hysteroscopy was significantly greater than at HSG. CONCLUSION(S): THL in association with minihysteroscopy provided more information and was better tolerated than HSG in an outpatient infertility investigation.     

Results of a prospective comparative study of transvaginal hydrolaparoscopy and chromolaparoscopy in the diagnostics of infertility

Transvaginal hydrolaparoscopy (THL) was evaluated in comparison with the already established chromolaparoscopy in the detection of tubal factors, adhesions as well as endometriosis. 43 infertile patients without previous pelvic operations and with an inconspicuous clinical examination were included in a prospective comparative study of THL and chromolaparoscopy. THL succeeded in 40 patients (93.0%). Both methods showed 100% agreement with regard to tubal factors and adhesions. However, only 72/80 tubes (90.0%) could be portrayed by THL. In contrast to this, THL failed to identify 8 of 10 laparoscopically verified endometrioses (isolated endometriosis of the bladder peritoneum in 2). No complications occurred with THL. THL could be the method of choice for the clarification of mechanical infertility factors in symptom-free patients with no suspicion of pelvic pathologies. Tubal pathologies and/or adhesions (visible during THL) should be indications for laparoscopy. In the case of inconspicuous genitals during THL and a still unfulfilled desire for offspring postoperatively, laparoscopy should be considered in order to exclude the possibility of unidentified endometriosis. Retroflexio uteri should at least be a relative contraindication for THL. Further studies are necessary to evaluate the role of THL in the diagnostic concept of infertility in the future.     

Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: results of 612 patients

AIM: To clarify the role of a combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility in developing countries. METHODS: In a prospective study, 612 consecutive infertile women underwent complete fertility evaluation at a tertiary university infertility clinic: 300 complained of primary infertility, 221 of secondary infertility, and 91 were requesting reversal of a previous tubal ligation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of their routine infertility evaluation. Focused hysteroscopic evaluation of the region of utero-tubal junction was attempted. RESULTS: Laparoscopy was successful in 608 and hysteroscopy in 597 patients. The most frequent pathologies detected hysteroscopically in the infertile group were adhesive in nature and believed to be post-traumatic and/or post-phlogistic. The number of intrauterine abnormalities found by hysteroscopy was significantly greater than by hysterosalpingography. The rate of diagnosis of significant lesions by laparoscopy of 64.3% rose to 76.6% when the hysteroscopic findings were included. A significant number of women with secondary infertility had abnormal hysteroscopic findings when compared to either women with primary infertility or those requesting sterilization reversal. Hysteroscopic evaluation of the region of utero-tubal junction revealed significant lesions believed to have caused infertility in comparison with those requesting sterilization reversal. CONCLUSION: The combined diagnostic approach of laparoscopy and hysteroscopy is recommended in the evaluation of female infertility in communities where the risk of pelvic infections is great.     

Ultrasonographically guided transvaginal hydrolaparoscopy

Transvaginal hydrolaparoscopy was introduced as an outpatient procedure to examine the tubo-ovarian complex in infertile women. We evaluated ultrasonographically guided transvaginal hydrolaparoscopy (UTHL) as a modified technique for pelvic examination in 562 infertile women without overt evidence of pelvic pathology. Access to the abdominal cavity was observed by ultrasound and examination of the pelvic structures was done by hydrolaparoscopy using saline solution. Access was successful in all cases. No perforation of bowel or rectum was detected. Bilateral visualization of the tubo-ovarian complex was successful in 96% of women. Mild asymptomatic peri-ovarian adhesions were detected in 17% of the women, 4.9% had grade I endometriosis. There was unilateral tubal occlusion in 5%, and bilateral in 3.6%. In 13.9% elective operative laparoscopy for tubal obstruction and/or adhesions was recommended. UTHL is a safe outpatient procedure for examination of the tubo-ovarian complex. The use of ultrasound increases the rate of successful access to the pouch of Douglas and minimizes complications.     

经阴道注水腹腔镜联合宫腔镜检查不孕症的临床观察

目的 探讨经阴道注水腹腔镜(THL)联合官腔镜检查不孕症的临床效果和应用价值。方法 对46例不孕症患者施行THL联合宫腔镜检查,其中原发性不孕(原发组)和继发性不孕(继发组)各23例。观察患者的输卵管通畅性、盆腔病变情况,记录THL手术时间、总手术时间、离院时间、术后阴道壁穿刺孔愈合时间、穿刺成功率与术中及术后并发症。结果原发组术后输卵管双侧通畅13例,继发组术后输卵管双侧通畅5例;两组比较,差异有显著性(P<0.05);原发组盆腔粘连6例,继发组盆腔粘连14例,两组比较,差异有显著性(P<0.05);术后需要进一步施行常规腹腔镜手术的患者仅7例(7/46,15％);46例不孕症患者THL手术时间、总手术时间、术后离院时间和阴道壁穿刺孔愈合时间分别为(10.5±1.7)min、(32.2±4.6)min、(87.3±12.5)min和(4.5±0.5)d;穿刺成功率为96％(46/48);无直肠损伤、术后穿刺部位出血、盆腔感染等并发症发生。结论 THL具有准确、微创、安全、经济、不需住院等优点,联合应用宫腔镜检查效果更佳。THL和宫腔镜联合检查可作为不孕症早期检查的一线方法。     

Minimally invasive exploration of the female reproductive tract in infertility

Classically, invasive and non-invasive tests are performed to evaluate the causes of infertility. Transvaginal hydrolaparoscopy (THL) allows the exploration of the pelvic structures with a mini-endoscope, using a vaginal needle-guided trocar introduction technique and saline as a distension medium. A first study on 349 patients demonstrated the feasibility of the procedure and gave a high patient satisfaction. Access to the pouch of Douglas was achieved in 330 patients (94.5%) under local anaesthesia and in an ambulatory environment. The mean pain score measured on a visual analogue scale of 10 was 2.7, comparable to the score of mini-hysteroscopy only and significantly lower than the scores of hysterosalpingography with either metal cannula or balloon catheter. A total of 96% of the patients agreed to repeat the procedure under the same circumstances if required. The diagnostic accuracy of the technique was demonstrated in a prospective study, in which two independent endoscopists explored 10 patients with both THL and standard laparoscopy. The inter-observer agreement for ovarian adhesions was 75% for standard laparoscopy and 90% for THL. In addition, in patients with mild endometriosis, more peri-ovarian adhesions were detected with THL than with standard laparoscopy. A multinational survey to evaluate the risk and outcome of bowel injury during THL registered 24 (0.65%) cases in 3667 procedures. In all cases, the diagnosis was made immediately and the treatment was conservative without complications.     

Transvaginal hydrolaparoscopy

Transvaginal hydrolaparoscopy (THL) is a modification of culdoscopy that can be used to evaluate the posterior uterus, pelvic sidewalls, and adnexae. Diagnostic THL can be done in the office under local anesthesia. Combined with diagnostic hysteroscopy and chromotubation, it can replace hysterosalpingography (HSG) as the first-line diagnostic test for the infertile woman. Studies have shown high patient tolerability with less pain reported postprocedure than with HSG. THL has been shown to have a high concordance with HSG for tubal patency, but THL diagnosed more intrauterine abnormalities as well as finding adhesions and endometriosis not visible with HSG. In addition, salpingoscopy may be performed during THL to assess the tubal lumen. THL also has a high concordance rate with laparoscopy when a complete evaluation is accomplished during THL. Complications of THL are uncommon and minor. Finally, operative procedures such as ovarian drilling, coagulation of endometriosis, lysis of adhesions, treatment of ovarian cysts, and salpingostomy may be performed via THL.     

Postcoital recovery of sperm in Douglas pouch aspirates of infertile patients

Tubal dysfunction is certainly involved in some cases of infertility. Clinical diagnostic procedures for tubal patency are occasionally misleading and contradictory. Moreover, they provide no information on tubal function. The recovery of viable sperm in Douglas pouch aspirates (DPA) was used to evaluate tubal function in 94 infertile patients with different tubal findings at hysterosalpingography (HS) and laparoscopy. Sperm recovery in DPA of ten infertile patients with poor or negative postcoital Sims- Huhner test results demonstrated the limitation of this test for evaluation of sperm transport in the female genital tract. Laparoscopic aspiration of DP may be performed in infertile patients undergoing chromosalpingoscopy as a part of their infertility investigation. The procedure should be supplementary to other available diagnostic parameters.     

Fallopian tubes and ultrasonography: the Sion experience.

OBJECTIVE: To compare the accuracy of three new ultrasonographic methods of detecting tubal patency and pathology with established methods like hysterosalpingography (HSG) and laparoscopy. DESIGN: Sixty-seven cases were evaluated by performing the Sion test using endosonography to check for tubal patency. The Sion procedure includes filling up the pouch of Douglas with approximately 300 mL of sterile normal saline to elucidate not only the patency but visualize the motility, the fimbriae, and peritubal adhesions, if present. We have compared the accuracy of this procedure with HSG and laparoscopy in 24 infertile women. Color-coded duplex Doppler sonography was used in 38 patients to check for tubal patency. RESULTS: Our experience at the Sion Hospital using the three new ultrasonographic techniques for evaluating the status of the fallopian tubes is very encouraging. The accuracy with the three modes shows agreement in > 90% of cases with established investigative modalities such as HSG and laparoscopy. CONCLUSION: These three new investigative modalities are offered not as substitutes for HSG, laparoscopy, hysteroscopy, or salpingoscopy but as office-screening procedures that would be complementary to the armamentarium of infertility investigations already available.     

The cost of laparoscopy in the diagnosis of female infertility

DESIGN: The aim of the study was to estimate the usefulness of laparoscopy in diagnostics of women's infertility. MATERIALS AND METHODS: This study is a retrospective review of the notes of 133 infertile women who had undergone laparoscopic procedures--in 88 (66.2%) patients the reason of their infertility was unknown (study group I) and in 45 (33.8%) pelvic pathology (PCO syndrome-37 cases, endometriosis-6 cases and tubal inpatency-2 cases) was supposed (study group II). RESULTS: In 96 (72.2%) patients (in 51 from group I and in 45 from group II) pelvic pathology was estimated (p < 0.0001 in comparison with diagnostic estimation before laparoscopy). Most frequent pathology in women with unexplained infertility was seen: endometriosis, adhesions and tubal inpatency. During laparoscopy procedure we changed totally preoperative diagnosis in 43.6% patients (58 cases--51 from group I and 7 from group II) and in 9.8% women additional pelvic abnormalities were detected. CONCLUSION: In authors opinion the laparoscopic procedure is very helpful in infertile women and ought to be included in diagnostic standard in cases of unexplained infertility.     

Diagnostic and operative transvaginal hydrolaparoscopy for infertility and pelvic pain

STUDY OBJECTIVE: To review our experience with diagnostic and operative transvaginal hydrolaparoscopy (THL), a procedure that is less invasive than operative laparoscopy. DESIGN: Prospective, observational cohort study (Canadian Task Force classification II-2). SETTING: Private institute and university-affiliated hospital. PATIENTS: Twenty-nine women with infertility and 11 with pelvic pain. INTERVENTIONS: Diagnostic and operative THL. MEASUREMENTS AND MAIN RESULTS: Thirty-five (88%) diagnostic THLs were performed in the office and the other five were done in hospital for insurance reasons; all six operative THLs were performed in the office under conscious sedation. The procedure was conclusive (all organs seen) in 37 patients (93%). Based on THL, no further surgical intervention was recommended in 18 (62%) infertile women and 5 (45%) of those with pain. Further surgical intervention was required in 5 (56%) of 9 infertility patients with a previous normal hysterosalpingogram (HSG) and 6 (32%) of 19 infertility patients with no previous HSG. CONCLUSION: Transvaginal hydrolaparoscopy can be performed in the office with minimal pain, with a conclusive examination anticipated in 93% of cases. The procedure is more accurate than HSG and similar to laparoscopy.     

Chlamydia trachomatis in cervical canal and in the pouch of Douglas in infertile women

The results of microbiological examination of samples from cervical canal of the uterus and from pouch of Douglas in 71 women who underwent diagnostic and operative laparoscopy is presented. In 33 cases diagnosed because of infertility Chlamydia trachomatis was present in 2 (6.1%) women and in one woman both in cervical canal and pouch of Douglas. In second woman only in cervical canal Chlamydia trachomatis was present. There was not statistically significant correlation between control and study groups.     

腹腔镜检查不育症盆腔疾病916例分析

目的应用腹腔镜诊断技术,评价腹腔镜诊断不育症的价值。方法采用德国Storz型腹腔镜,对916例不育症妇女的盆腔疾病和不育的影响进行分析。结果916例妇女中837例(91．37％)找到了盆腔疾病的病因。盆腔粘连、子宫内膜异位症和输卵管炎是引起不育症的主要盆腔疾病。除宫内膜异位症外,原发不孕症中,又以内生殖器官发育异常、盆腔结核、多囊卵巢多见。继发不孕症以盆腔粘连、输卵管炎多见。继发不孕组中,有宫腔操作史占98．40％。结论应用腹腔镜诊断技术对不育症的诊断价值在于能早期明确不育症盆腔病因,可在直视下通液,动态观察输卵管通畅度和形态,并对由于盆腔疾病所引起的不育症的预后影响作出一定判断。     

A study of second-look laparoscopy after acute salpingitis

Acute salpingitis (AS) has a major impact on the reproductive health of women. In this study second-look laparoscopy was assessed for its ability to predict reproductive function after AS. We questioned 158 women who had had a second-look laparoscopy with tubal dye insufflation after laparoscopically proven AS between September 1984 and August 1989. The answers of 69 women with at least two years of involuntary infertility were analyzed. The mean follow-up period was 76 months (range 53–108 months). Second-look laparoscopy revealed bilateral tubal occlusion in 21.7% (15/69). Bilateral tubal occlusion was found in 9.5% (2/21) after mild stage, 20% (4/20) after moderate stage and 32.1% (9/28) after severe stage AS. The rate of infertility during follow-up was 9.5% (stage I), 35% (stage II) and 39.9% (stage III). Eighty per cent (12/15) of women with proven bilateral tubal occlusion after treated AS had involuntary infertility, and 14.8% (8/54; P=0.000001) of women with one or both tubes patent also had infertility. Specificity, sensitivity and positive predictive value for subsequent infertility were 85.2%, 80% and 84.1%, respectively. Pelvic adhesions (21/69) were strongly correlated with bilateral tubal occlusion (8/21; 38.1%; P=0.029), a history of chronic pelvic pain (14/21; 66.7%; P=0.00024), as well as failure to achieve an intrauterine pregnancy (10/21; 47.6%; P=0.024). Recurrent pelvic infections occurred in 16% (12/69) and ectopic pregnancies in 7.3% (5/69). Operations for infertility and pelvic pain (excluding ectopic pregnancy), were carried out in 11.6% (8/69). We conclude that second-look laparoscopy after treated AS have accurate evaluation of reproductive function. Received: 10 January 1996 / Accepted: 29 April 1996     

Organ preserving endosurgery in pyosalpingitis]

Pyosalpinges are a difficult therapeutic problem in a complicated pelvic inflammatory disease. To avoid a diffuse peritonitis, often a laparotomy with salpingectomy is performed. 20 women of reproductive age with a uni- or bilateral pyosalpinx were incorporated in a prospective study to investigate the possibilities of a combined endosurgical/antibiotical treatment. After endoscopic confirmation, the patients were taken into study. During diagnostic laparoscopy, a salpingotomy with rinsing of the tubes and a drainage of the Douglas pouch took place. After one week of antibiotic treatment, a second-look laparoscopy was performed in all patients; no recurrence was documented. The combination of endosurgery and chemotherapy showed to be a safe and efficient therapy of tubal abscesses in women of reproductive age.     

The usefulness of transvaginal hydrolaparoscopy in infertile women with abnormal hysterosalpingogram results but with no obvious pelvic pathology

Objective

To evaluate the value of transvaginal hydrolaparoscopy (THL) in infertile women with abnormal hysterosalpingogram results but with no history of previous pelvic surgery and with normal gynecological examination and vaginal sonography.

Study design

This is a retrospective study. From January 2008 to October 2009, 51 infertile women were planned to undergo standard laparoscopy because of abnormal HSG. None of the patients had any history of previous pelvic surgery and all had normal findings on gynecological examination and vaginal sonography. These women underwent THL.

Results

Among the 51 cases, successful access to the pouch of Douglas was achieved in 49. There were two failures due to obesity, and the operation was converted to standard laparoscopy. No complication was observed in this study period. In 26 patients (53.1%) the THL procedure showed normal pelvic organs. Four patients were lost to follow-up. Of the remaining 22 cases, four became pregnant (4/22, 18.2%) through intercourse or intrauterine insemination (IUI). There were some morphologic abnormalities seen in the remaining 23 patients such as adhesions, endometriosis and hydrosalpinx. Six cases with mild adhesions and endometriosis were treated with THL alone, and four (4/6, 66.7%) became pregnant with or without IUI. Among the 19 who underwent standard laparoscopy, three were lost to follow-up. In the other 16 cases, natural pregnancy occurred in six (6/16, 37.5%) patients with or without IUI.

Conclusions

For women with abnormal HSG results but with no obvious pelvic pathology, THL should be recommended and about 50% could avoid an unnecessary laparoscopy. Adhesiolysis and coagulation of endometriotic lesions under THL in mild adhesion and endometriosis cases could lead to encouraging results.     

腹腔镜和宫腔镜在不孕症诊治中的应用

本文对320例不孕症患者行腹腔镜检查,其中47例同时行宫腔镜检查及治疗。腹腔镜检查结果表明,盆腔炎症和子宫内膜异位症是本组病例中最常见的病因,占77.5％,由此引起的盆腔粘连和输卵管阻塞占71.33％,而这些病例56.9％(110/255)没有临床表现,因此腹腔镜检查是诊断盆腔炎和子宫内膜异位症的可靠方法。47例宫腔镜检查发现异常占21.3％,其中27例49条阻塞输卵管在宫腔镜下加压通液及行插管术,其中8例11条输卵管通畅,占29.6％,4例妊娠。因此对HSG或腹腔镜检查发现的输卵管阻塞,特别是近端阻塞,可在腹腔镜监视下,行宫腔镜加压通液或输卵管插管再通术以减少误诊。