中药灌肠配合宫腔镜下输卵管插管注药治疗输卵管阻塞性不孕临床观察

目的：观察中药灌肠配合宫腔镜下输卵管插管注药治疗输卵管阻塞性不孕患者的临床疗效。方法：治疗组35例采用中药灌肠配合宫腔镜下输卵管插管注药方法治疗;对照组30例,采用宫腔镜下输卵管插管注药方法治疗。治疗前后进行输卵管通畅程度的观察评价。结果：治疗组输卵管通畅率达84.85%,对照组治疗后通畅率62.50%,经统计学处理P〈0.05,治疗组的疗效明显高于对照组。结论：中药灌肠配合宫腔镜下输卵管插管注药在治疗治疗输卵管阻塞性不孕方面疗效确切。     

宫腔镜下插管注药在持续异位妊娠治疗中的应用

我们在宫腔镜下插管注药治疗全身用药失败的输卵管妊娠中取得了满意的疗效，现报道如下。     

宫腔镜下插管注射甲氨蝶呤治疗输卵管妊娠的护理

宫腔镜直视下输卵管插管注射甲氨蝶呤（MTX）治疗输卵管妊娠，具有简单安全、高效微创、用药剂量小、药物副反应轻、住院时间短等诸多优点，目前已应用于早期输卵管妊娠。我院自2002年3月-2005年3月，对121例早期输卵管妊娠病人进行宫腔镜直视下输卵管插管注射MTX治疗，取得了良好的疗效。现将手术护理介绍如下。     

宫腔镜在子宫下部异位妊娠误诊后应用6例分析

目的：探讨宫腔镜在子宫下部异位妊娠诊治中的价值。方法：回顾性分析6例子宫下部异位妊娠误诊后行人流术患者的临床资料,术中、术后大出血,经对症支持治疗后行宫腔镜探查。结果：6例子宫下部异位妊娠均得到明确诊断及有效治疗。结论：宫腔镜作为一种微创手段,在宫颈妊娠及子宫峡部妊娠诊治中发挥重要作用,迅速止血同时切除病灶并保留子宫。     

宫腔镜下输卵管插管通液术诊治不孕症346例分析

目的:研究宫腔镜下输卵管通液诊治不孕症的可行性及实用性。方法:346例不孕症患者行宫腔镜下输卵管插管通液检查和治疗。结果:346例不孕症中经检查发现,双侧输卵管通畅72人,双侧输卵管通而不畅203人,其中双侧输卵管通而极不畅53人,双侧输卵管梗阻18人,经插管反复加压注药,通而不畅203人中有151人完全通畅。结论:宫腔镜下输卵管插管通液手术治疗不孕症为较普通的通液术,其准确性高,可作不孕症病人的首选检查和治疗手段。     

宫腔镜与腹腔镜联合治疗输卵管阻塞性不孕

目的探讨宫腔镜与腹腔镜联合治疗输卵管阻塞性不孕的临床应用价值。方法在腹腔镜监护下经宫腔镜进行输卵管插管注药，在输卵管充盈后进行输卵管整形，使输卵管得以复通。结果和结论对于输卵管阻塞性不孕患者，宫腔镜与腹腔镜联合治疗，创伤小、效果好、治愈率高。     

宫腔镜下输卵管插管注药治疗输卵管妊娠

探讨宫腔镜下输卵管插管单次局注射氨甲喋呤(MTX)治疗输卵管妊娠的疗效。方法：对28例输卵管妊娠患者采用宫腔镜下输卵管插管局部注射MTX40mg治疗，定时监测血β—HCG直至正常，附件区包块消失，月经恢复。结果：27例插管成功，成功率96．4％，治愈率100％，此法操作简便，损伤小，副作用少，患者乐于接受。结论：宫腔镜下输卵管插管注射MTX治疗输卵管妊娠是可行的。     

宫腔镜插管注入氨甲蝶呤配合中药治疗输卵管妊娠临床研究

目的 利用宫腔镜下输卵管插管注入氨甲蝶吟配合中药对输卵管妊娠进行治疗。方法 200例输卵管妊娠患者，在宫腔镜下将导管插入患侧输卵管口，注入氨甲蝶呤60mg，同时服用中药治疗。B超观察妊娠囊内胚芽、原始心搏消失情况以及血β-HCG下降情况。结果 190例包块直径〈5cm，β—HCG值在10．6-34．7μg／L，孕龄在36-56d患者，经治疗后10-16dβ—HCG下降至正常，B超示2d后胚芽及原始心搏消失，1、2个月包块吸收。10例患者，孕龄平均60d，包块直径〉5cm，β—HCG值在45．0-86．5μg／L，用药后腹痛加剧2例，β—HCG持续不下降，包块增大8例，均行腹腔镜手术治疗。结论 宫腔镜下输卵管插管注入氨甲蝶呤配以中药治疗，对孕周小、β-HCG值低、包块直径〈5cm的输卵管妊娠患者治疗有效。     

宫腔镜下插管输卵管疏通术治疗输卵管不通效果观察

目的探讨宫腔镜下插管输卵管疏通术治疗输卵管不通的临床效果。方法以2009年1月至2010年期间本院收治的106例输卵管不通的患者为研究对象,随机分为观察组和对照组,对照组给予B超引导下输卵管通液术治疗,观察组给予宫腔镜下插管输卵管疏通术治疗,比较治疗前后输卵管的通畅情况变化,随访1年,观察患者的妊娠情况。结果观察组术后输卵管通畅者39例,通畅率为73.58%,对照组通畅者32例,通畅率为60.38%,差异具有统计学意义(P<0.05);术后1年,观察组成功宫内妊娠者37例,成功妊娠率为69.81%,对照组成功妊娠者28例,成功妊娠率为52.83%,差异具有统计学意义。观察组异位妊娠2例,发生率为3.77%,对照组3例,发生率为5.66%,差异无统计学意义。结论宫腔镜下插管输卵管疏通术治疗输卵管不通的成功率高于B超引导下宫腔通液术,宫内妊娠成功率较高,治疗效果良好,具有较高的临床应用价值。     

宫腹腔镜诊治特殊部位异位妊娠的价值

目的探讨腹腔镜、宫腔镜诊治特殊部位异位妊娠的价值。方法回顾性分析本院使用腹腔镜和(或)宫腔镜诊治的114例特殊部位异位妊娠患者的临床资料。结果 114例患者中有1例发生子宫穿孔,5例发生持续性异位妊娠,6例出血超过200ml,都及时予以处理,预后良好。结论宫腹腔镜是治疗特殊部位异位妊娠相对安全有效的方法,其手术并发症是可以积极预防并妥善处理的。     

Sonographically guided minimally invasive treatment of unusual ectopic pregnancies.

OBJECTIVE: To present our experience with sonographically guided treatment of unusual ectopic pregnancies, defined as heterotopic pregnancies and pregnancies occurring at ectopic locations other than the extracornual portion of the fallopian tube. METHODS: We retrieved and reviewed all cases of unusual ectopic pregnancies that underwent sonographically guided therapy at our institution. Twenty-seven cases were identified, from 1992 through 2003, including 18 cervical, 6 cornual, 1 tubal heterotopic, and 2 cesarean scar implantations. RESULTS: All of the cervical ectopic, cornual ectopic, and tubal heterotopic pregnancies were treated by sonographically guided injection of potassium chloride into the ectopic gestational sac or fetus. Guidance was via transvaginal sonography in all 18 cervical pregnancies, 3 of the 6 cornual pregnancies, and the tubal heterotopic pregnancy, and via transabdominal sonography in 3 cornual ectopic pregnancies. One of the cesarean scar pregnancies was treated by transvaginally guided potassium chloride injection, and the other was treated via transabdominally guided dilation and evacuation. Treatment was successful in 25 of the 27 patients, including all 23 patients with an ectopic pregnancy and no concomitant intrauterine pregnancy. Four patients had concomitant intrauterine and ectopic pregnancies (1 cervical, 2 cornual, and 1 tubal); in 3 the intrauterine fetuses resulted in live-born infants, and in the fourth the intrauterine pregnancy was electively terminated. Eight of the 27 patients had subsequent intrauterine pregnancies. CONCLUSIONS: Sonographically guided minimally invasive treatments of unusual ectopic pregnancies are safe and effective alternatives to surgical and systemic medical therapy. These treatments ablate the ectopic pregnancy, permit normal continuation of a concomitant intrauterine pregnancy, and preserve the uterus for subsequent pregnancies.     

异位妊娠经腹腔镜治疗265例分析

该文总结了1990年－1999年8月共265例异位妊娠患者于腹腔镜下治疗结果,其中输卵管切除术55例,保守性手术197例,切开取胚缝合修补术155例,切开取胚胎开窗术25例,吸引术18例,镜下注射氨甲蝶呤13例,中转手术5例,镜下注射氨甲蝶呤3例,镜下切开取胚胎开窗术1例,均中转剖腹患侧输卵管切除术;1例镜下切开输卵管缝合修补术改为镜下患侧输卵管切除术。要求保留生育功能者114例,有生育要求者37例,宫内妊娠15例（80．84％）,足月分娩10例,再次异位妊娠4例（10．81％0。     

Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series.

OBJECTIVES: To describe a series of consecutive cases of live ectopic pregnancies managed with ultrasound-guided local injection of methotrexate (MTX) or potassium chloride (KCl). METHODS: Eighteen consecutive women with live and unruptured, tubal, cornual or cervical ectopic pregnancies referred to our unit for evaluation and management underwent risk-benefit counseling. Under transvaginal ultrasound guidance, puncture and injection of the ectopic pregnancy was performed using an automated puncture device. Either MTX or KCl was injected, producing immediate cessation of fetal cardiac activity. RESULTS: Of the 18 ectopic pregnancies, 10 were cervical, four were tubal and four were cornual. The mean initial beta-hCG level was 33 412 IU and the mean gestational age was 6 + 6 weeks. Ten ectopic gestational sacs were injected with KCl and eight were injected with MTX. There was no difference in time to resolution of the ectopic pregnancies between those injected with KCl and those with MTX. CONCLUSIONS: Unruptured live ectopic pregnancies of many types can be successfully managed without surgical intervention through local injection of KCl or MTX.     

宫腹腔镜手术联合中药治疗近端输卵管性不孕

目的 探讨宫腹腔镜联合3F导管导丝辅助中药治疗输卵管近端阻塞性不孕的临床价值.方法 先采用宫腔镜、腹腔镜和导管导丝三者联合的方法治疗输卵管阻塞89例患者共169条输卵管,术后对成功疏通的86例患者随机分成A、B两组,A组给予中药辅助治疗3个月,B组无特殊治疗.结果 169条输卵管中119条经插入3F导管疏通,未通的50条改为导丝治疗,45条疏通,总的疏通率为97.04％(164/169);疏通成功的86例患者中有34例宫内妊娠,其中,A组妊娠22例,B组妊娠12例,两组之间差异有显著性(P＜0.05).结论 宫腹腔镜联合导管导丝可以最大限度地发挥它们的优点,提高输卵管疏通成功率高,术后辅助中药治疗是十分必要的,它提高了术后的妊娠率.     

Ectopic pregnancy treatment using pelviscopic or vaginosonographically-guided intrachorionic injection of methotrexate and POR 8.

It is believed by some that the basis of modern first-trimester pregnancy care should involve screening for ectopic pregnancy using vaginal ultrasonography. This has led to this condition being diagnosed in most cases at an earlier stage than has previously been possible. This advance in diagnostic ability has introduced the concept of conservative management for this condition.The authors describe the conservative management of nine cases of ectopic pregnancy using intrachorionic injection of either methotrexate alone or in combination with POR 8. In all cases less than 9 weeks had passed since the last menstrual period, and the ectopic pregnancies treated under ultrasound control were all thought to be viable. Five cases were treated using pelviscopy, whilst in another four the needle was guided using vaginal ultrasonography. There were no procedure-related complications.Following therapy, the women were followed up using serial levels of serum beta-hCG. In seven cases there was a gradual reduction to normal levels. There were two treatment 'failures'. In both these cases methotrexate alone, rather than in combination with POR 8, was used for injection. Although formal tests of tubal patency have not been performed in all cases, one woman in the series has since conceived and has a normal intrauterine pregnancy.It is concluded that vaginal instillation of methotrexate is an alternative treatment for early ectopic pregnancy. It should be limited to viable ectopic pregnancies whose chorionic cavities are less than 2.0 cm in diameter. A plan for the management of ectopic pregnancy is presented, involving selection for both ultrasound-guided injection and pelviscopic surgery. Laparotomy is not considered to be a treatment option in the majority of cases.     

Conservative management of live tubal pregnancies by ultrasound guided potassium chloride injection and systemic methotrexate treatment

Unruptured live tubal ectopic pregnancies are often managed surgically. Significantly elevated beta-hCG levels in these patients make treatment with methotrexate ineffective. However, achieving cardiac asystole via sonographically guided injection of potassium chloride (KCl) along with systemic methotrexate can improve treatment outcome. We describe the successful conservative management of 3 cases of unruptured tubal pregnancy with cardiac activity and significantly elevated beta-hCG levels. Under sonographic guidance, KCl was injected into the fetal heart to achieve cardiac asystole, and patients concurrently received a systemic methotrexate injection. The resolution of ectopic pregnancy was achieved and surgery was avoided in all 3 cases. Conservative management may thus be an option for patients with live ectopic pregnancies.     

宫腹腔镜联合行输卵管全程插管再通术疗效分析

目的 探讨宫腔镜一腹腔镜联合行输卵管插管术在治疗输卵管性不孕中的临床价值。方法 对121例因输卵管阻塞引起不孕症患者采用宫腔镜-腹腔镜联合手术，在腹腔镜监视下先行宫腔镜输卵管口插管至输卵管开口内约1cm，并加压通液术，若失败则沿输卵管口插入外导管后，再插入内芯3～14cm疏通输卵管全程。结果 121例患者共210条输卵管经宫腔镜输卵管口插管通液术后再通为63条，占30．00％，而经输卵管全程插管术后的患者再通为134条，占63．81％（P〈0．01）。结论 宫腹腔镜联合行输卵管全程插管再通术，具有疗效好、成功率高、损伤小等特点，是目前治疗输卵管阻塞的较好方法。     

联合应用宫腔镜和腹腔镜治疗输卵管性不孕的围术期护理

[目的]总结联合应用宫腔镜和腹腔镜治疗输卵管性不孕的围术期护理措施。[方法]回顾性分析102例输卵管性不孕症病人行宫腔镜和腹腔镜联合治疗的临床资料。[结果]本组病人双侧输卵管完全通畅18例,输卵管一侧通畅14例,输卵管积水92条,输卵管间质部、峡部阻塞62条,经治疗疏通44条;术后随访58例6个月～24个月,宫内妊娠28例,输卵管妊娠3例。[结论]加强输卵管性不孕症病人行宫腔镜和腹腔镜联合治疗的围术期护理是手术成功的保证。     

宫腔镜诊治子宫内膜息肉临床分析

目的 分析宫腔镜诊治子宫内膜息肉的临床价值。方法 宫腔镜检查子宫异常出血患者260例，对诊为子宫内膜息肉者行宫腔镜手术，术后加用孕激素治疗。结果260例异常子宫出血患者中，子宫内膜息肉83例，占31．9％，均经病理证实。78例镜检同时进行了治疗，5例择期行电切术，随访6个月～2年，复发5例，治愈率95．2％，无并发症发生。结论 宫腔镜诊断子宫内膜息肉准确率高、创伤小，并能同时进行治疗，疗效肯定。     

Conservative treatment of ectopic pregnancies using a single echo-guided injection of methotrexate into the gestational sac.

The authors describe the possibility of the conservative treatment of five early ectopic pregnancies. A single injection of methotrexate into the tubal gestational sac was performed under vaginal ultrasound guidance. In all five cases, a clear ectopic gestational sac could be visualized. The pregnancies dated from the 5th to the 7th week of amenorrhea. Strict ultrasound follow-up following injection showed a gradual reduction in the size of the tubal gestational sac. At the same time, plasma beta-hCG gradually decreased to zero after a maximum time period of 25 days. Subsequent hysterosalpingography performed on all of the women demonstrated bilateral normal patent tubes.It is concluded that, in selected patients, transvaginal injection provides an alternative relatively non-invasive approach to the management of ectopic pregnancy. It is proposed that the adoption of a policy of earlier diagnosis and treatment may lead to a reduction in the incidence of some tubal causes of infertility.