宫腔镜腹腔镜联合诊治不孕症166例分析

从 1998年 1月 1998年 12月 ,笔者在上海医科大学妇产科医院 ,对 16 6例不孕患者进行宫腔镜、腹腔镜联合诊治 ,效果良好 ,报道如下。1　资料与方法1 1　一般资料　我们从 1998年 1月 1998年 12月收集不孕患者 16 6例 ,年龄 2 32 4岁 ,其中原发不孕 75例 ,继发不孕 91例 ;原发不孕中不孕最长年限 10年。继发不孕中流产次数最多 4次 ,末次人流距今最长 9年 ;经输卵管通液治疗次数最多 2 4次(每月 8次 )。克罗米芬治疗时间最长 8个月。1 2　方法　采用德国Ｗｉｓａｐ公司生产手术腹腔镜、宫腔镜、内凝固控制装置及内凝固器械。患者全部采用全麻…     

B超宫腔镜在不孕症诊治中的联合应用

多年来我院对初诊的不孕症患者如无禁忌证均行常规输卵管通液检查(以下简称初筛)。对初筛异常者进行反复通液治疗,取得一定疗效,但效果不很理想。2002年5月以后我们对初筛异常者采用B超、宫腔镜联合进行检查及插管治疗取得良好效果。现报道如下。1　资料与方法1.1　一般资料　把2002年5月至2004年5月初筛输卵管不通者共62例(122条输卵管),不孕时间18个月至12年,平均(360±098)年,年龄23~41岁,平均(2782±560)岁作为观察组。2000年4月至2002年4月初筛输卵管不通者共56例(111条输卵管),不孕时间1~11年,平均(352±087)年,年龄23~39岁,平均…     

腹部B超监导下宫腔镜输卵管插管通液术治疗输卵管性不孕症──102例临床分析

随着宫腔镜和Ｂ超在妇科临床应用中经验的积累及其在女性不孕症诊治中应用的重大进步,与传统治疗相比,它不仅使诊断精确,而且有助于不孕症的治疗。本文简介腹部Ｂ超监导下宫腔镜输卵管插管通液术治疗输卵管性不孕症治疗的经验和体会。 资料与方法 一、资料来源 自１９９８年１月至１９９９年１２月间来我院就诊的不孕症妇女,其丈夫精液检查正常,基础体温双相或经阴道Ｂ超监测卵泡发育,证实排卵和子宫、附件正常,并均在外院经宫腔输卵管通液试验ｌ～３次拟为输卵管阻塞性不孕１０２例,共２０４条输卵管。其中原发不孕４０例,继发不…     

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：     

宫腹腔镜联合诊治输卵管性不孕症的价值

目的:探讨宫、腹腔镜联合诊治输卵管性不孕症的临床应用价值。方法:回顾分析2010年5月至2012年4月在我院住院行宫、腹腔镜联合诊治术的177例输卵管性不孕症患者的临床资料,并随访其术后妊娠情况。结果:患者术后的自然妊娠率为40.11%(71/177),其中70.42%发生于术后6个月内(50/71);异位妊娠率为3.39%(6/177)。患者的术后自然妊娠率与不孕时间呈显著负相关(β=-0.178,P0.05),而与年龄和不孕症类型无关。结论:宫、腹腔镜联合诊治术对输卵管性不孕症的诊断和治疗均具有临床应用价值,对术后1年未自然妊娠者应积极行辅助生殖技术治疗。不孕时间越长,术后自然妊娠的可能性越小。     

宫腔镜、腹腔镜、B超、输卵管碘油造影对不孕症病因的诊断分析

目的 :通过宫腔镜、腹腔镜、B超、输卵管碘油造影 (HSG)检查 ,比较各项检查在不孕症诊断中的诊断价值。方法 :选择 38例不孕症患者进行宫腔镜、腹腔镜、B超、输卵管碘油造影检查。结果 :诊断宫腔内病变 ,B超检出率为1 3 2 % ,HSG检出率为 2 6 % ,宫腔镜检出率为 39 5 % ;诊断盆腔内病变 ,B超检出率为 39 5 % ,HSG检出率为 2 1 1 % ,腹腔镜检出率为 84 2 %。结论 :宫腔镜、腹腔镜检查在不孕症中的应用优于B超及输卵管碘油造影 ,但不能取代 ,应相互补充应用 ,四项检查在诊断不孕症中有一定的应用价值     

宫腔镜联合B超诊治IUD取出困难312例分析

宫腔镜联合B超在诊治宫内节育器(IUD)取出困难中具有直观、安全、准确等优点，我院共实施312例。现报道如下。     

输卵管性不孕症临床诊治进展

输卵管性不孕症是不孕症的主要原因之一。其发病率逐年增高,临床疗效不满意,为探讨其临床诊治方法、疗效、目的,现对近年来输卵管性不孕症的诊治方法进行小结。     

宫腔镜联合腹腔镜在输卵管性不孕中的应用

<正>输卵管病变占女性不孕因素的1/3。近年,妇科微创技术在不孕症诊治方面的优越性日益凸显。2003年至2006年,我院应用宫腔镜、腹腔镜联合手术诊治输卵管性不孕症,对术式及应用价值进行了探讨,现报道如下。     

腹腔镜联合宫腔镜诊治输卵管性不孕52例分析

目的探讨应用宫、腹腔镜对输卵管性不孕的诊断价值及治疗效果.方法对52例经子宫输卵管碘油造影(HSG)诊断为输卵管性不孕的患者,单用腹腔镜下子宫导管内加压注入美蓝液检查证实双侧输卵管通畅者8例,一侧通畅者4例,双侧因各不同部位梗阻而不通者40例.对双侧及一侧不通的44例患者,根据不同部位病变进行治疗,如盆腔粘连松解,伞端扩张、造口及宫腔镜下输卵管间质部插管加压通液,开腹显微外科输卵管吻合、宫角植入等.结果52例输卵管性不孕患者中,双侧榆卵管通畅40例(77%),单侧通畅10例(19%),完全不通2例(3.9%).结论应用宫、腹腔镜联合检查、治疗输卵管性不孕,可避免单独使用宫腔镜、腹腔镜或开腹整形的局限性,提高诊断的准确性及治疗效果.     

Evidence-based diagnosis and management of tubal factor infertility

PURPOSE OF REVIEW: The investigation for potential tubal disease is an essential step in the work-up of infertility. This review article provides an evidence-based overview of the diagnosis and management of tubal factor infertility. RECENT FINDINGS: While laparoscopic chromopertubation remains the gold standard in the diagnosis of tubal disease and hysterosalpingography is still widely used, newer modalities offer some advantages. Sonohysterography with the use of contrast medium is superior to hysterosalpingography and comparable to laparoscopic chromotubation in diagnosing tubal blockage. Chlamydia serology is the most cost-effective and least invasive diagnostic test for tubal disease, and it is comparable to, if not better than, hysterosalpingography. Depending on the nature and degree of tubal dysfunction as well as the age and ovarian reserve of the patient, various treatments for tubal infertility are available. For proximal tubal obstruction, transcervical tubal cannulation with tubal flushing is a reasonable first approach. Surgical techniques for tubal repair, such as salpingostomy or fimbrioplasty for distal tubal obstruction, can provide good results. Still, tubal factor remains a major indication for in-vitro fertilization and embryo transfer, which bypasses the tubal problem altogether. In certain situations, such as the presence of hydrosalpinx, prophylactic surgery can be used in conjunction with in-vitro fertilization and embryo transfer. SUMMARY: As with infertility in general, the diagnosis and management of tubal infertility should be tailored to the individual patient. Future studies should help to further clarify the role of the various diagnostic tests and therapeutic approaches for tubal infertility.     

宫腔镜下输卵管插管通液术与子宫碘油造影诊断输卵管性不孕作用的研究

目的:比较宫腔镜下输卵管导管通液术与子宫输卵管碘油造影(HSG)诊断输卵管性不孕的临床价值。方法:对2008年1月至2009年12月880例不孕症患者行宫腔镜下输卵管插管通液术,术前均常规行子宫输卵管碘油造影术,比较两者诊断的符合率并分析两种检查方法在评价输卵管通畅度方面的特点和应用价值。结果:子宫输卵管碘油造影和宫腔镜插管通液均诊断输卵管不通784条,通畅799条,通而不畅65条,两者符合率93.6%(1648/1760),不符合率6.4%(112/1760)。HSG检查输卵管通畅度的假阳性率为11.8%(107/906)。结论:宫腔镜下输卵管导管通液术能更精确地判断输卵管的通畅度,患者未接触有害物质,同时可以直接观察宫腔情况并治疗。在判定输卵管梗阻部位方面HSG优于宫腔镜检查。     

输卵管性不孕症的诊治进展

<正>输卵管具有拾卵子、精子和早期胚胎的运送功能,又是正常的受精场所。输卵管因素不孕是女性不孕症中最常见的原因之一,在不孕的夫妇中有12%属输卵管因素[1]。如何正确诊断输卵管不孕及其严重程度,并相应地选择治疗手段,一直是很多学者和临床医师都在探讨与探索的问题。本文就输卵管性不孕症的诊断及治疗,及其重要性质的重视进行探讨。     

输卵管性不孕的诊治现状及研究进展

在不孕症的诊疗中,通常要进行输卵管疾病的诊断和治疗。目前妇科内镜(腹腔镜联合宫腔镜)已经作为诊断和评价输卵管性不孕的金标准,并成为治疗的主要手段之一。但由于其费用高、创伤性相对较大,使其使用受到了一定的限制。子宫输卵管造影术广泛用于临床,它作为初步筛查的首选方法得到普遍肯定。选择性输卵管造影和介入疏通术在诊断及治疗输卵管阻塞方面优于子宫输卵管造影术,在一定程度上可与腹腔镜相媲美。经阴道注水腹腔镜是近年来的新兴技术,在国内使用较少,由于其准确、安全、方便、经济、快速的优点,值得临床推广。     

Economic evaluation of infertility treatment for tubal disease

Purpose : The number of published studies comparing cost-effectiveness of tubal surgery and IVF treatment is limited, in part because of the difficulties of conducting randomized trials, given that IVF is now a clinically accepted treatment and the decision to offer surgery or IVF is often dictated by the severity of the tubal disease and by the availability of the methods. The aim of this study was to compare the costs of our policy of offering tubal surgery to patients with mild or moderate tubal disease with the cost of offering IVF to these and severe tubal disease. Methods : In this retrospective cohort study patients with tubal pathology as the sole reason for their infertility were included: 61 patients in the tubal surgery group and 464 patients in the IVF group. The delivery rates and costs per delivery were compared. Results : Delivery rates were 28% in the tubal surgery group within 2 years of follow-up and 52% in the IVF group that involved up to three cycles of treatment. This economic evaluation demonstrated only small differences in the average cost when considering the cost per delivery. Conclusions : With a policy involving strict selection of patients, tubal surgery will continue to have a role in the treatment of infertility.     

Office hydrolaparoscopy for the diagnosis of endometriosis and tubal infertility.

Transvaginal hydrolaparoscopy has been described as an office procedure that is particularly suitable for the diagnosis of endometriosis and adhesions. It is recommended as a first line procedure in patients with infertility. The procedure is performed under local anaesthesia or sedation in an office setting. The abdominal distension is achieved by transvaginal instillation of warm saline using a combined Veress needle-trocar system. The exploration under fluid allows the inspection of the tubo-ovarian structures in their natural position and the easy identification of endometriotic lesions and adhesions in the posterior pelvis. The limitation of the inspection to the posterior pelvis is not a major problem for the diagnosis of endometriosis because exclusively anterior pelvis endometriosis is rare and of doubtful significance in infertility. Transvaginal hydrolaparoscopy can be performed in the office setting in combination with minihysteroscopy, tubal patency test and salpingoscopy, offering major advantages for the diagnosis of pelvic disease in patients with infertility.     

Ectopic pregnancy following the treatment of tubal infertility.

To evaluate the prognosis for the patient who becomes pregnant after infertility treatment, we analyzed the occurrence of ectopic pregnancy following reconstructive surgery and in vitro fertilization/embryo transfer (IVF/ET) for tubal infertility. The results of 474 microsurgical operations and the results of 2,119 stimulated IVF/ET cycles for tubal infertility in the Reproduction Unit of Ljubljana University Department of Obstetrics and Gynecology are presented. The ratio of patients who subsequently had only ectopic pregnancies to the number of operations was 12%. Ectopic pregnancies represented 28% of all pregnancies after surgery. In IVF/ET cycles for tubal infertility, ectopic pregnancy represented 2.8% of all pregnancies and 3 permiles of all transfers. There was one (0.5%) heterotopic pregnancy. The likelihood of live births (30%, one or more times) after surgery compensates the high risk for ectopic pregnancy. While the risk for ectopic pregnancy after IVF/ET is much lower than the risk after tubal surgery, it is still rather high compared with the risk in the normal population. In the cases with severe tubal lesions IVF/ET is preferable to tubal surgery. The results show the importance of considering ectopics when deciding upon treatment and in patients who become pregnant after treatment for tubal infertility.     

Nonsurgical diagnosis and treatment of tubal pregnancy

These data suggest that EP can be diagnosed and safely treated medically with MTX using the scheme outlined with no laparoscopy. Laparoscopic removal can be reserved for those patients with large unruptured EP (greater than 3.0 cm; cardiac activity) or the individual who requires laparoscopy for diagnosis.     

Rational diagnosis and treatment in infertility

Subfertility is a statistical concept. When a pregnancy has not been achieved within a year of unprotected intercourse, the odds are that an underlying pathological mechanism is at play. Advanced female age, longer duration and primary infertility, are important prognostic factors, suggestive of low fecundity and indicating a need for further diagnosis and treatment. Many diagnostic tests only have screening value and the only gold standards are hysteroscopy and laparoscopy. Severely impaired semen quality should lead to andrological work-up. Postcoital test and endometrial biopsy are obsolete. Treatment should preferably be aetiological, such as in anovulation, and sometimes also in endometriosis and tubal infertility. Primary treatment of male infertility is not proven to be advantageous. Conception-enhancing techniques such as intrauterine insemination (IUI), in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), have shown to be effective. As a rule, and where possible, IUI is preferred and only if four to six cycles have failed should IVF be offered.