宫腹腔镜下输卵管插管通液联合导丝介入治疗输卵管近端梗阻的临床研究

目的:探讨宫腹腔镜下双侧输卵管插管通液联合Cook导丝介入治疗输卵管近端梗阻的疗效。方法:选择23例经子宫输卵管碘油造影诊断为双侧输卵管近端梗阻的患者行宫腔镜下双侧输卵管插管通液联合Cook导丝介入治疗。结果:23例不孕症患者45条输卵管近端梗阻输卵管插管通液成功27条,经Cook导丝介入治疗后通液成功15条,手术再通率93.33%。术后随访21例妊娠9例,妊娠率39.13%。结论:宫腹腔镜下双侧输卵管插管通液联合Cook导丝介入治疗输卵管近端梗阻具有微创、输卵管再通率高、妊娠率高的特点。     

宫腹腔镜联合导丝治疗双侧输卵管近端梗阻临床体会

目的：探讨宫腔镜、腹腔镜联合导丝治疗输卵管近端梗阻的疗效。方法：首先对碘油造影诊断为输卵管近端梗阻的患者,进行必要的腹腔镜手术治疗,然后行美蓝通液,进一步了解输卵管梗阻情况,再在腹腔镜监视下对近端梗阻的输卵管行宫腔镜下导丝治疗。结果：150例双侧近端输卵管梗阻患者中,136例双侧输卵管通畅,术后再通率90.67%。95例坚持治疗,3月后85例输卵管通畅,再通率89.47%。妊娠66例,妊娠率44%。结论：宫腔镜、腹腔镜联合导丝治疗输卵管近端梗阻具有可视、微创、输卵管再通率高、可提高妊娠率的优点。     

宫腔镜、腹腔镜联合导丝治疗双侧输卵管近端梗阻临床分析

目的探讨宫腔镜、腹腔镜联合导丝治疗输卵管近端梗阻的疗效。方法首先对碘油造影诊断为输卵管近端梗阻的患者,进行必要的腹腔镜手术治疗,然后行美蓝通液,进一步了解输卵管梗阻情况,再在腹腔镜监视下对近端梗阻的输卵管行宫腔镜下导丝治疗。结果65例双侧近端输卵管梗阻者中58例双侧输卵管获通,术后再通率89.23%,其中48例坚持治疗,3月后42例输卵管通畅,再通率87.50%,妊娠23例,妊娠率35.38%。结论宫腔镜、腹腔镜联合导丝治疗输卵管近端梗阻具有可视、微创、输卵管再通率高、可提高妊娠率的优点。     

宫腹腔镜联合手术和子宫输卵管碘油造影在输卵管性不孕中的应用价值

育龄妇女中各种原因所致的不孕症约占10％,其中输卵管性不孕的发病率较高,占不孕症病因的30％～40％。随着宫腔镜、腹腔镜的诊断和治疗技术在妇产科领域的应用和普及,宫腹腔镜联合手术为输卵管性不孕的治疗开辟了一条新途径。子宫输卵管碘油造影（hysterosalpinggography,HSG）广泛应用于不孕症检查中。本文旨在探讨宫腹腔镜联合检查与子宫输卵管碘油造影在诊断子宫输卵管性不孕中的一致性及宫腹腔镜联合在诊治子宫输卵管性不孕的价值。     

Cook导丝介入治疗输卵管阻塞性不孕的疗效分析

输卵管阻塞是不孕症的常见原因，占不孕患者的30％以上。2005年6月至2007年12月我院采用宫腹腔镜联合Cook导丝介入术治疗，成功率达93．28％，现报告如下。     

宫腹腔镜术联合中药五联疗法治疗输卵管不孕46例

目的:探讨宫腹腔镜手术后配合中药口服、中药保留灌肠、中药热敷、低频脉冲电治疗、针灸治疗输卵管阻塞性不孕的临床疗效。方法:将确诊为输卵管阻塞性不孕症的92例患者随机分为治疗组和对照组。两组均采取宫腹腔镜手术及术后输卵管插管通液治疗,治疗组术后加用中药口服、中药保留灌肠、中药热敷、低频脉冲电治疗、针灸五联疗法,对照组术后未使用五联疗法。随访其妊娠情况。结果:治疗组正常妊娠34例,占73.9%;对照组正常妊娠18例,占39.1%,经统计学分析有显著性差异(P<0.05)。结论:宫腹腔镜手术联合中药五联疗法是治疗输卵管阻塞性不孕的有效方法,值得临床推广应用。     

宫腹腔镜联合手术加用透明质酸钠防治输卵管疏通术后再阻塞效果分析

宫、腹腔镜联合手术是目前治疗输卵管阻塞性不孕的主要方法,但如何防止术后再粘连、再阻塞仍是临床需要解决的难点。我院在宫腹腔镜联合手术中加用透明质酸钠预防术后再粘连、再阻塞,取得满意效果,现报道如下。1资料与方法1.1一般资料2005年2月至2006年2月将我院因输卵管阻塞性不孕行输卵管疏通术的53例,分为两组:(1)宫、腹腔镜联合手术结合透明质酸钠防治输卵管疏通术后再阻塞23例(宫、腹 透明质酸钠组);(2)单纯宫、腹腔镜联合手术治疗输卵管性不孕30例(宫、腹腔镜联合手术组)。病例纳入标准:(1)婚后同居2年,男方生殖功能正常,未避孕而未受…     

宫腹腔镜联合诊治输卵管性不孕症40例分析

不孕症是影响男女双方身心健康的疾病。在女性因素所致的不孕症中，输卵管因素占1／3。既往常规行输卵管通液和子宫输卵管碘油造影来判断输卵管是否通畅，但准确率不高，且达不到有效治疗目的。近年来，多个研究中心推荐输卵管通液宫腹腔镜联合检查作为输卵管通畅度的检查治疗方法，我院应用宫腹腔镜联合检查和治疗不孕症患者40例，取得了良好效果，报道如下：     

输卵管梗阻选择性介入放射复通术85例临床报告

输卵管梗阻或盆腔粘连占女性不孕症的３６％～８５％〔１〕，输卵管近端阻塞又占输卵管梗阻的１０％～２５％〔２〕。以往主要采用剖腹输卵管子宫植入术及吻合术，但临床治疗效果较差。自１９９３年起，我们对输卵管间质部及峡部梗阻采用介入放射复通术，现将资料完整的８...     

宫腹腔镜联合手术在剖宫产瘢痕妊娠治疗中的应用分析

目的 探究在剖宫产瘢痕妊娠治疗中应用宫腹腔镜联合手术治疗的临床效果。方法 选取100例剖宫产瘢痕妊娠患者,遵循随机数字表法将患者分为对照组与研究组,各50例。对照组进行B超导向下清宫术治疗,研究组进行宫腹腔镜联合手术治疗。比较两组患者围手术治疗各项指标,并评估患者术后生活质量及记录患者术后并发症发生情况。结果 两组手术时间比较差异无统计学意义(P>0.05);而研究组术中出血量少于对照组,住院时间、月经复常时间以及血人绒毛膜促性腺激素(HCG)转阴时间均短于对照组(P<0.05)。研究组躯体功能、心理功能、物质生活状态及社会功能评分分别为(76.48±6.69)分、(77.84±6.82)分、(75.72±6.47)分、(77.26±7.73)分,均高于对照组的(65.37±5.74)分、(67.37±5.74)分、(66.48±5.53)分、(64.72±5.83)分(P<0.05)。研究组术后并发症发生率为6.00%,低于对照组的20.00%(P<0.05)。结论 在剖宫产瘢痕妊娠治疗中应用宫腹腔镜联合手术治疗可取得更佳的疗效,患者术中风险、术后并发症更低,...     

宫腔镜下输卵管双层插管治疗输卵管梗阻108例效果分析

目的 :为进一步提高宫腔镜下插管治疗输卵管严重梗阻的疏通率及术后妊娠率。对象和方法 :本文对 1 0 8例患有输卵管完全或部分梗阻导致不孕的妇女 ,在宫腔镜窥视下经第一次插管注液不能疏通者 ,进行双层插管疏通治疗。结果 :经第一次插管注液完全疏通的输卵管由术前的 3.30 %上升到 33.0 2 % (P<0 .0 5) ,在此基础上进行双层插管 ,完全疏通率 33.0 2 %上升到 57.59% (P<0 .0 5) ,经第二次宫腔镜检查 ,完全疏通率略有下降 ,但 P>0 .0 5。术后一年随访 ,怀孕 33例 (30 .56 % )。结论 :宫腔镜下输卵管双层插管对输卵管严重梗阻有较好疗效 ,可提高术后怀孕率     

腹腔镜监测下宫腔镜输卵管插管术治疗输卵管近端梗阻的疗效分析

目的：分析腹腔镜监测下宫腔镜输卵管插管术（laparoscopy-guided hysteroscopic tubal catheterization,LHTC）治疗输卵管近端梗阻的临床疗效。方法：回顾性分析2010年1月—2012年12月因单纯输卵管近端梗阻在中国人民武装警察部队后勤学院附属医院住院行LHTC的336例患者临床资料。术后随访2年,观察其术后妊娠率及妊娠结局。结果：LHTC术中总的输卵管复通率为54.70%,总的患者复通率为63.10%。术后至少一侧输卵管通畅组和未能复通组的术后2年自然妊娠率分别为43.40%和8.06%,活产率分别为33.96%和7.26%,差异均有统计学意义（P＜0.05）。结论：行LHTC治疗输卵管近端梗阻的疗效确切,该术式可以作为治疗输卵管近端梗阻的首选方法。     

Outcome of Laparoscopy-Guided Hysteroscopic Tubal Catheterization for Infertility Due to Proximal Tubal Obstruction

Study ObjectiveTo determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization.DesignClinical cases series (Canadian Task Force classification II-3).SettingReproductive surgery center.PatientsPatients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included.InterventionsLaparoscopy-guided hysteroscopic tubal catheterization.Measurements and Main ResultsOnly the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years).ConclusionSuccessful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization.     

宫-腹腔镜联合治疗子宫内膜异位症合并不孕患者术后妊娠的影响因素分析

目的:探讨宫-腹腔镜联合治疗子宫内膜异位症(EMT)合并不孕患者术后妊娠的影响因素。方法:选择2012年4月至2014年4月于厦门市妇幼保健院行宫-腹腔镜联合治疗的EMT合并不孕患者共340例为研究对象,随访18~42月,分析影响术后妊娠率的临床因素。结果:292例完成随访,随访率85.88%(292/340),术后妊娠165例(56.51%)。其中术后1~6月、7~12月、13~24月、25~42月分别妊娠115例(39.38%)、40例(13.70%)、8例(2.74%)、2例(0.68%),差异有统计学意义(χ~2=11.76,P0.05)。多因素分析结果显示:年龄≥35岁、不孕年限≥3年、r-AFS分期高是影响患者术后妊娠的独立危险因素(OR=10.45、3.03、3.74,P0.05);继发不孕、使用促排卵治疗是影响术后妊娠的独立保护因素(OR=0.23、0.33,P0.05)。结论:EMT合并不孕患者采用宫-腹腔镜联合治疗可获得较好的术后妊娠率,术后1年内是妊娠最佳时机。患者年龄≥35岁,不孕年限≥3年,r-AFS分期高可影响术后妊娠率,使用促排卵药物治疗对提高妊娠率有益。     

Effect of Premedication Hyoscine-N-Butylbromide before Hysterosalpingography for Diagnosis of Proximal Tubal Obstruction in Infertile Women: A Randomized Double-Blind Controlled Trial

Study Objective

To assess the effect of hyoscine-N-butylbromide (HBB) as premedication on the rate of proximal tubal obstruction during hysterosalpingography (HSG).

80对不孕症夫妇解脲支原体感染与输卵管阻塞的关系

目的:探讨夫妇双方生殖道解脲支原体(UU)感染与女方输卵管阻塞的关系.方法:采用聚合酶链反应技术(PCR),对80例不孕妇女(不孕组)和63例早孕拟行人工流产术的妇女(对照组)进行UU检测.不孕患者施行同月经周期子宫输卵管造影(HSG),结果按输卵管通畅和输卵管阻塞分组.不孕患者丈夫精液同步进行UU培养及检测,精液常规分析并计数白细胞.结果:不孕组UU感染率(42.5%)明显高于对照组(17.4%).不孕组中夫妇双方UU检测均阳性16例,输卵管通畅4例,输卵管阻塞12例;仅男方阳性11例,输卵管通畅为4例,输卵管阻塞7例;仅女方阳性18例,输卵管通畅为7例,输卵管阻塞为11例;夫妇双方均阴性35例,输卵管通畅27例,输卵管阻塞8例.夫妇任何一方UU检测阳性与输卵管通畅度成负相关.丈夫精液UU检测阳性与妻子输卵管通畅度成负相关.精液UU阳性组白细胞计数升高率显著高于UU阴性组;精液检测UU阳性组精液常规异常检出率(51.9%)明显高于阴性组(28.3%).结论:UU可能是引起输卵管阻塞的病原体之一,不孕症男方精液中UU感染能够导致精液常规异常,并与女方输卵管阻塞密切相关.     

The learning curve of selective salpingography and tubal catheterization

OBJECTIVE: To determine the effect of increasing experience in fluoroscopically guided selective salpingography and tubal catheterization on radiation doses and screening times, thus establishing a learning curve for the procedure. DESIGN: Retrospective case note analysis. SETTING: IVF center of an academic teaching hospital. PATIENTS: Three hundred sixty-six patients with infertility seen over 3.5 years. INTERVENTION(S): Fluoroscopically guided selective salpingography and tubal catheterization. MAIN OUTCOME MEASURE(S): Reductions in radiation doses and screening times for different categories of selective salpingography and tubal catheterization, expressed as percentage reductions during the study period and reductions per 10 procedures. RESULT(S): During the study period, The median dose of radiation decreased by 62.6%-71.9%, and the median screening time declined by 61.5%-78.5%. Reductions per 10 procedures were 2.5%-4.2% and 2.7%-5%, respectively. CONCLUSION(S): Significant reductions in radiation doses and screening times start early in a clinical team's practice of selective salpingography and tubal catheterization and continue even as trainees are added to the pool of operators.     

宫腔镜输卵管注药治疗输卵管梗阻性不孕症(附54例临床分析)

本文报道54例(含102条输卵管)输卵管梗阻性不孕妇女,经宫腔镜输卵管插管注药术治疗三次,治疗前、后均作子宫输卵管碘油造影比较。治疗后86条输卵管通畅度改善(84%),与治疗前有非常显著性差异(P<0.01),其中56条输卵管通畅(54.9%),30条好转(29%)和16条无效(16%),按输卵管条数计,此术用于输卵管通而欠畅者疗效最佳(85.7%),宫角梗阻疗效较好(62.5%),而伞部梗阻疗效最差(13.3%)。治疗后输卵管通畅的35例中,随访1～12月已有12例获宫内妊娠。     

注射用过氧化碳酰胺声学造影对输卵管阻塞的诊断价值

目的:评价注射用过氧化碳酰胺声学造影对输卵管阻塞的诊断价值。方法:选择不孕症妇女124例,采用注射用过氧化碳酰胺为造影剂,行经阴道超声引导下输卵管声学造影术,其中46例行腹腔镜检查。结果:双侧输卵管通畅52例,部分通畅46例,输卵管阻塞26例。注射用过氧化碳酰胺造影诊断的敏感性为84.2%,特异性为94.1%,阳性预测值为91.4%,阴性预测值为88.9%。结论:注射用过氧化碳酰胺声学造影可作为一种评价输卵管通畅性的有效方法。     

Comparison of the pain experienced by infertile women undergoing hysterosalpingo contrast sonography or radiographic hysterosalpingography

Objective

To evaluate the pain and cause of pain experienced by women undergoing hysterosalpingography (HSG) and contrast hysterosalpingo sonography (HyCoSy) with air in a saline solution for the assessment of uterine and tubal patency.

Method

In this prospective study, 121 infertile women undergoing these 2 procedures measured the pain incurred using a digital/analog scale (1-10). We looked for correlations between pain level and variables pertaining to the procedures. Vagal effects and their persistence were also recorded.

Results

The pain was less during HSG (median, 5) than during HyCoSy (median, 7). It was greater than menstrual pain for 38.8% of participants during HSG and for 70.5% of participants during HyCoSy. There was no correlation between pain and difficult catheter passage, degree of tubal obstruction, volume of contrast medium injected, or presence of IgG antibodies to Chlamydia when these variables were studied for HyCoSy alone. However, the strong correlation between pain score and volume of contrast medium injected during each procedure seems to explain the significantly higher pain levels during HyCoSy (P < 0.001). In 65.3% and 57.8% of participants, respectively, the pain disappeared immediately after the HSG or HyCoSy. Only mild vagal effects were recorded following both procedures, in 0.8% of participants after HSG and 2.5% of participants after HyCoSy.

Conclusion

Hysterosalpingo contrast sonography is similar to HSG regarding rapidity of pain disappearance, and infrequency and moderation of vagal effects, but the level of pain is slightly higher, probably due to the greater volume of medium injected.