腹腔镜在不孕症中的应用

目的探讨腹腔镜在诊治不孕症中的应用价值。方法对200例女性不孕症患者进行腹腔镜诊断性检查、输卵管美蓝通液及相应的镜下治疗。结果200例中经腹腔镜诊断为慢性盆腔炎并输卵管病变109例(54.5%);子宫内膜异位症55例(27.5%),其中Ⅰ~Ⅱ期的18例,Ⅲ~Ⅳ期的37例;多囊卵巢综合征12例(6%);盆腔结核8例(4%);内生殖器畸形4例(2%);正常盆腔12例(6%)。60例经腹腔镜治疗后妊娠(30%)。结论腹腔镜术在女性不孕症的诊治中具有其他技术不能替代的重要价值,应作为女性不孕症诊治中的一种常规方法。     

腹腔镜手术治疗子宫内膜异位症156例临床疗效分析

目的探讨腹腔镜手术治疗子宫内膜异位症的临床疗效。方法回顾分析156例子宫内膜异位症在腹腔镜下进行诊断手术的经验。结果156例内异症患者154例通过腹腔镜成功完成手术,2例因盆腔广泛粘连、子宫多发性肌瘤合并腺肌瘤,操作困难中转开腹。62例行卵巢子宫内膜异位囊肿剥除术(单侧38例,双侧24例),异位病灶电凝或内凝术122例,同时行粘连松解术84例,输卵管造口术36例,子宫肌瘤剔除术8例,输卵管通液术94例,双侧输卵管通畅46例,单侧通畅36例,双侧阻塞12例。手术时间30～120 min,平均78min。术中出血5～50 ml,平均20 ml。均无严重并发症发生。跟踪随访120例,痛经70例中38例痛经症状消失,8例明显减轻,总有效率65.7%。94例不孕者中40例妊娠,妊娠率42.6%。结论腹腔镜手术治疗子宫内膜异位症安全、有效、利于恢复,尤其对合并不孕症患者,可明确诊断,又可同时治疗,提高妊娠率。     

腹腔镜治疗不孕症58例体会

近年来不孕症患者有增多趋势,腹腔镜检查可以直接窥视输卵管、卵巢、子宫有无病变,以及盆腔有无粘连,并可以分离粘连,治疗子宫内膜异位病灶、子宫肌瘤等。我们通过对58例不孕症患者应用腹腔镜诊治的临床资料进行回顾性分析．探讨腹腔镜手术在不孕症诊治中的价值。     

子宫输卵管造影对不孕症的病因初步分析

子宫输卵管疾患是造成女性不孕的重要因素，而子宫输卵管造影是不孕症诊断的秣方法。地输卵管炎症、阻塞，子宫粘连，子宫粘膜下肌瘤，子宫畸形及盆腔粘连可做出比较明确的诊断，我们通过造地近年来不孕症的病因进行初步分析，以期对本病的预防和治疗提供帮助。     

腹腔镜输卵管切除或保留手术对输卵管妊娠患者生殖潜能的影响

目的 探讨腹腔镜下行保留输卵管或切除输卵管手术对输卵管妊娠患者后期生育潜能的影响,并评估其临床价值及应用前景.方法 回顾性分析2005年1月-2010年6月143例因输卵管妊娠收入解放军总医院行腹腔镜治疗患者的临床资料并电话随访术后2年内的妊娠情况,其中保留输卵管患者69例,切除输卵管患者74例.结果 两组患者社会生物学特征无明显差异.69例保留输卵管者随访59例,失访10例,其中宫内妊娠32例(32/59,54.2％),再次异位妊娠9例(9/59,15.3％).74例切除输卵管者随访66例,失访8例,其中宫内妊娠30例(30/66,45.5％),再次异位妊娠7例(7/66,10.6％).两组术后2年累积妊娠情况差异无统计学意义(P＞0.05).分析患者术后再次妊娠情况,发现术后宫内妊娠患者比再次异位妊娠或继发不孕者的盆腔粘连少、输卵管形态异常少,术后检查输卵管通畅率高,差异有统计学意义(P＜0.05).结论 腹腔镜下保留或切除输卵管对于术后患者宫内妊娠无明显影响.盆腔粘连、输卵管形态异常可导致术后再次不良妊娠,而宫腔镜检查通畅有助于术后宫内妊娠.     

B超引导下盆腔子宫输卵管显影术1360例护理体会

我国不孕不育患者数量呈逐年上涨趋势,女性不孕已成为困扰现代女性的一个重大问题。不孕症病因复杂,其中输卵管因素引起的不孕占女性不孕症的12％～33％。输卵管性不孕是指由于输卵管不同部位阻塞或粘连引起的不孕,B超引导下盆腔子宫输卵管显影术是近20年逐渐发展起来的输卵管检查方法之一。我院从2007-01开展B超引导下盆腔子宫输卵管显影术,至今已完成1360例。为了进一步提高护理质量,减轻手术带给患者的痛苦,现将我院对盆腔显影术患者的护理工作情况总结如下。     

不孕症165例病因分析

1992～ 2 0 0 1年 ,我们采用腹腔镜诊断不孕症16 5例 ,使其诊断率得到了提高。现将病因进行分析。1　临床资料1 1　一般情况　本组年龄 2 4～ 4 5岁。原发性不孕10 6例 ,继发性不孕 5 9例。不孕 1 5～ 12年 ,其中 6年以上 2 9例。男方精液均正常。1 2　不孕症诊断标准及方法　诊断标准 :(1)子宫附件有粘连 ,输卵管纡曲、充血 ,常规压力下通液 ,双侧输卵管不通 ,加压通液后一侧或双侧通畅或仍然不通者诊断为输卵管炎 ;(2 )盆腔见子宫内膜异位灶者诊断为子宫内膜异位症 ;(3)双侧卵巢增大 ,包膜厚 ,可见血管、多个滤泡 ,未见近期排卵痕迹 (排卵…     

子宫输卵管造影在不孕症诊断中的价值

目的：探讨子宫输卵管造影在不孕症诊断中的价值。方法：对69例女性不孕症(配偶精液检查正常)患者行子宫输卵管造影检查，根据有无妊娠史分为两组：原发不孕组和继发不孕组，比较两组问年龄、不孕年限及输卵管通畅性，并结合病史、体征综合分析查找女性不孕原因。结果：两组问年龄不孕年限之问差异无显著性，但两组问输卵管通畅性之问有差异，继发不孕组输卵管不通支数显著高于原发不孕组。结论：子宫输卵管造影是不孕症病因诊断的方法之一，尤其对继发不孕患者的病因诊断更有意义。     

腹腔镜下CO2激光治疗不孕妇女子宫内膜异位症

本组采用ＣＯ２激光经腹腔镜治疗患子宫内膜异位症的不孕妇女７５例，无严重并发症。术后随访６０例中，妊娠２２例，妊娠率３３．６％，校正妊娠率４２．２％，７７．３％的患者在术后半年内妊娠。术后８８．３％的患者痛经好转或消失，７３．６％的患者性交痛减轻或消失。腹腔镜下ＣＯ２激光治疗子宫内膜异位症之优点是在诊断同时治疗本病，能准确、彻底地消除内膜异位病灶、创面不出血、术后无粘连、住院时间短、恢复快，还能同时     

子宫输卵管造影联合腹腔镜检查在诊断输卵管性不孕中的应用

目的：探讨碘海醇子宫输卵管造影联合腹腔镜检查在诊断输卵管性不孕中的应用价值。方法选择60例输卵管性不孕患者进行该项研究,先后进行碘海醇子宫输卵管造影和腹腔镜检查。结果60例输卵管不孕患者,114条输卵管子宫输卵管造影（HSG）诊断输卵管阻塞85条,腹腔镜检查诊断出93条输卵管阻塞,两种检查手段在诊断输卵管阻塞方面差异无统计学意义（P＞0．05）。慢性盆腔炎、子宫内膜异位症及盆腔结核是引起输卵管阻塞的主要原因。HSG诊断输卵管性不孕的灵敏度为81．7％,（76/93）,特异性为57．1％,（12/21）,漏诊率为18．3％,误诊率为42．9％。HSG诊断盆腔病变的灵敏度为41．4％,特异度为46．4％,误诊率为53．6％,漏诊率为58．6％。结论碘海醇子宫输卵管造影联合腹腔镜检查可明显提高输卵管性不孕的诊断率,明确具体病变部位,HSG对输卵管阻塞可作为首选检查,但对盆腔病变诊断价值有限,其灵敏度远不及腹腔镜,二者联合可提高对不孕患者病因的准确判断。     

Peritubal adhesions in infertile women: diagnosis with hysterosalpingography

We studied the efficacy of hysterosalpingography in the detection of peritubal adhesions without tubal occlusion by using laparoscopy as the gold standard for the diagnosis. Peritubal adhesions were diagnosed on hysterosalpingography by using the following radiographic criteria alone or in combination: (1) convoluted fallopian tube, (2) loculation of spillage of contrast medium into the peritoneal cavity, (3) ampullary dilatation, (4) peritubal halo effect (double-contour appearance of the tubal wall), and (5) vertical fallopian tube. The first 100 patients with the diagnosis of adhesions on hysterosalpingography who also had laparoscopy were included in the study. Seventy-five patients had the diagnosis confirmed on laparoscopy, resulting in a 25% false-positive diagnosis of adhesions with hysterosalpingography. Thirty-nine (52%) of these 75 patients had one radiographic finding alone, and 20 of these patients had loculation of spillage of contrast medium. Although the patients with adhesions tended to have two or more of the radiographic findings, the difference was not statistically significant. The most frequent radiographic findings found in combination were convoluted fallopian tube and loculation of spillage of contrast medium. These findings suggest that hysterosalpingography can be the diagnostic procedure of choice in the initial investigation of infertility due to peritubal adhesions.     

子宫输卵管造影对不孕症的诊断价值

目的 论证子宫输卵管造影在不孕症中的诊断价值。方法 对986例不孕症患者行子宫输卵管碘油造影，在造影时和24h后各摄盆腔正位片1张。结果 986例造影中，子宫输卵管正常98例（9.9%），输卵管炎症及积水254例（25.8%），慢性盆腔炎320例（32.5%），子宫输卵管结核160例（16.2%），子宫先天发育畸形154例（15.7%）。结论 子宫输卵管造影对女性不孕症的病因诊断有重要价值，可为临床治疗提供客观依据。     

Clinical outcome in female patients with pelvic pain and normal pelvic US findings

PURPOSE: To understand the clinical outcome in patients with pelvic pain and negative pelvic ultrasonographic (US) findings. MATERIALS AND METHODS: Data from 86 female patients with pelvic pain and normal pelvic US findings seen in a US section over a 15-month period were evaluated 6-21 months after US. Medical chart review follow-up was available in 86 patients, and telephone interview follow-up was conducted in 85 patients. We collected data on the outcome of pain; subsequent imaging, treatment, and surgery; and the duration of pain before US. RESULTS: Pelvic pain improved or resolved in 66 (77%) of the 86 patients. In the group with acute or subacute pain (duration 6 months), seven (50%) of the 14 patients had improved symptoms. Further imaging (13 studies) was performed in nine patients: Twelve studies were normal, and one computed tomographic scan (1 month after the first US examination) showed diverticulitis. Eleven patients underwent 19 surgical procedures (endometrial sampling, hysteroscopy, laparoscopy, or hysterectomy). Four demonstrated clinically important disease (endometriosis and pelvic varices, endometriosis, adenomyosis, or pelvic adhesions). CONCLUSION: The majority of patients with pelvic pain and normal pelvic US findings had improvement or resolution of their symptoms, and those with acute or subacute pain were more likely to report improvement or resolution of pain than those with chronic pain. The yield of further imaging studies was low, and disease was identified in a minority of patients.     

压力法宫腔声学造影在不孕症诊疗中的应用研究

目的 :研究压力法宫腔声学造影 (PSHG)在不孕症诊疗中的临床价值。材料和方法 :收集PSHG诊疗的不孕症患者 5 2例 ,14例与X线子宫碘油造影 (X HSG)结果比较 ,12例与腹腔镜术结果比较 ,2 1例与宫腔通液术结果比较。结果 :PSHG在判断输卵管性不孕症原因时与其它方法无明显差异 ,在检查宫腔病变和治疗输卵管性不孕症时则明显优于其它检查。PSHG的敏感性为 98% ,特异性为 91,7% ,术后受孕率为 3 6 5 %。结论 :PSHG是一种切实可行的输卵管功能评价方法 ,对输卵管性不孕症的诊疗具有肯定的临床实用价值     

Pelvic endometriosis: MR imaging

The value of magnetic resonance (MR) imaging at 0.35 T in detecting, characterizing, and staging pelvic endometriosis was prospectively investigated in 30 consecutive women in whom this disease was clinically suspected. MR findings were correlated with the results of laparoscopy (13 women) and laparotomy (17 women). Surgical examination revealed a normal pelvis in five patients and endometriosis in 25. Three of the five normal cases and 16 of the 25 cases of endometriosis were correctly identified with MR imaging (sensitivity, 64%; specificity, 60%; accuracy, 63%). MR imaging demonstrated seven of eight endometriomas but only 14 of 29 adhesions and only six of 45 endometrial implants. While MR imaging demonstrated endometriomas, ovarian adhesions, and extraperitoneal endometrial implants, it could not accurately depict extraovarian endometrial adhesions and intraperitoneal endometrial implants. In addition, MR imaging findings did not correlate with the surgically determined severity of the disease. These limitations indicate that MR imaging cannot be used as the primary modality in the detection, characterization, and staging of endometriosis; laparoscopy remains the procedure of choice.     

腹腔镜手术对妇科疾病诊疗的应用

 目的 探讨腹腔镜手术在妇科疾病诊治中的临床价值.方法 回顾分析武警总医院、武警广州总队和重庆总队三家医院妇科,1995-08至2009-08腹腔镜下妇科各种手术21 015例,成功率99.44%(20898/21015).手术技巧改进,如改良脐部穿刺方法完成卵巢良性肿瘤剔除术;输卵管妊娠开窗取胚术;宫、腹腔镜联合诊治不孕症;"盆腔包块"切除联合腹膜代阴道成形术等.结果 完成卵巢良性肿瘤剔除术8148例(≥18 cm巨大囊肿56例);卵巢切除术136例;异位妊娠4645例,输卵管开窗取胚术4387例,切除输卵管258条;腹腔镜下粘连松解、通液输卵管不孕者共4930例,其中宫、腹腔镜联合治疗176例,随访12个月怀孕率为52.76%(86/176).腹腔镜下完成子宫肿瘤手术3021例,其中肌瘤剔除术418例、LAVH2362例、 TLH192例、 LASH49例;经阴子宫广泛切除术+盆腔淋巴结清扫21例;慢性盆腔痛粘连分解术69例;腹膜代阴道成形术45例.腹腔镜手术结局均良好.21015例手术中117例中转开腹,占0.56%,中转开腹原因以止血困难、盆腔严重粘连为主.结论 腹腔镜手术能够取代90%的妇科开腹手术.     

宫腔镜在辅助生殖中的应用意义分析

目的探讨宫腔镜检查术在辅助生殖技术中应用的重要性。方法回顾性分析2010年9月—2011年10月在我院接受检查的265例不孕症患者宫腔镜检查资料,其中90例患者因试管婴儿失败而行宫腔镜检查。结果 265例不孕患者中宫腔正常者124例,占46.8%,宫腔异常者141例,占53.2%。宫腔粘连86例(占32.5%),子宫内膜息肉39例(占15%),子宫内膜炎22例(占8.3%)。宫腔粘连在继发不孕中的检出率高于原发不孕。子宫内膜息肉的检出率在两组中无统计学差异。90例因试管婴儿失败而行宫腔镜检者中有68例存在宫腔病变(占76%),包括子宫内膜炎、子宫内膜息肉、宫腔粘连等。结论宫腔镜检查具有良好的可接受性和准确性,有较高的阳性发现率,可及时发现不孕症患者的宫内病变,应作为辅助生殖技术治疗前的常规检查。     

超声引导介入治疗妇科囊性病变的十年经验

目的:探讨彩色多普勒超声引导介入治疗妇科盆腔囊性病变的价值和方法。材料和方法:1997～2007年对1061例妇科囊性病变在彩色多普勒超声引导下根据病变位置及患者婚否选用经腹或经阴道穿刺抽液及无水酒精固化治疗(对213例最大径线>8.0cm的大囊肿采用无水酒精多次固化,每次凝固3min法,一次注入酒精量不超过60ml;多房囊肿每个房都要单独完成囊液抽吸及无水酒精固化),并行细胞学检查。术后随访3～24个月。结果:99.8%(1059/1061)的病例成功地完成了囊内液体的抽吸,治疗过程中无严重并发症发生。92.0%(976/1061)的病例通过一次超声引导介入治疗囊腔完全闭合。>8.0cm的囊肿一次治愈率为94.8%(202/213),3～24个月的累积复发率5.2%(11/213);卵巢子宫内膜异位囊肿3～24个月累积复发率8.3%,与腹腔镜等其他治疗学方法相似。结论:彩色多普勒超声引导穿刺抽液及无水酒精固化治疗妇科盆腔囊性病变疗效满意。     

Use of the sonographic contrast medium in the study of pelvic masses: preliminary remarks

PURPOSE: To evaluate the role of intravenously injected sonographic contrast medium (CM) in characterising space-occupying pelvic lesions. MATERIALS AND METHODS: Forty-seven women with palpable pelvic mass underwent color Doppler US before and after the intravenous injection of an ultrasound CM. The examination results were divided into three categories: Class I = no additional diagnostic information supplied by the contrast-enhanced examination; Class II = the use of CM facilitated the identification of vascular structures but did not significantly affect the diagnosis or the patient's subsequent diagnostic/therapeutic procedures; Class III = the information obtained significantly affected treatment decisions regarding the single patients. RESULTS: After the CM injection, 9/47 (19.1%) cases were assigned to Class I, 25/47 (53.2%) to Class II, and 13/47 (27.7%) to Class III. At baseline, all 13 lesions later assigned to Class III had shown an avascular appearance or only peripheral vascularisation. This type of vascular distribution was confirmed by the contrast-enhanced study, which helped determine the haemorrhagic nature (with solid appearance) of some lesions, or support the hypothesis put forward during the baseline study, that the lesion was a poorly vascularised benign mass. This lent further support to our choice to undertake a laparoscopic surgical approach in 2 lesions, it altered our decision as to the type of surgery to be performed (laparoscopy vs. laparotomy) in 5 patients, and confirmed our intention to undertake only the follow-up in the 6 remaining cases. CONCLUSIONS: The use of the sonographic CM proved clinically useful in 13/47 patients with space-occupying pelvic lesions. The most important result of this examination was its ability to confirm the nonvascular or poorly vascular component of a lesion, and therefore to suggest its benign nature.