腹腔镜手术治疗输卵管副开口的妊娠结局分析

目的探讨输卵管副开口的临床病例特点、诊断、处理方法及妊娠结局。方法回顾性分析2010年1月～2011年8月腹腔镜手术治疗的输卵管副开口19例的临床资料。输卵管副开口占同期不孕症腹腔镜手术的2．4％（19／793）。术中荷包缝合关闭副开口或打开副开口使其与伞端融合，同时去除盆腔子宫内膜异位病灶。合并子宫内膜异位症者术后给予促性腺激素释放激素激动剂（GnRH—a）治疗1～3个月。2例因术中同时切除子宫肌瘤需避孕2年而未纳入妊娠结局分析。17例术后随访12～19个月，统计妊娠率、流产率及持续妊娠率。结果19例输卵管副开口中，合并子宫内膜异位症占89。5％（17／19），其中88．2％（15／17）为早期子宫内膜异位症。3例术前子宫输卵管造影（HSG）结果提示输卵管远端粘连。输卵管副开口术后妊娠率为58．8％（10／17），均持续妊娠至停经20周以上。无宫外孕及自然流产发生。结论术前病史及HSG有助于输卵管副开口诊断，确诊需腹腔镜术中通液时仔细检查输卵管及伞端。输卵管副开口可能与子宫内膜异位症、不孕症有关。

Analysis of the Pregnancy Outcome of Laparoscopic Surgery for Accessory Ostium of Fallopian Tube

Objective To investigate the clinical manifestations, diagnosis, treatment and pregnancy outcome of accessory ostium of fallopian tube. Methods Retrospective analysis was conducted on 19 accessory ostium patients undergoing laparoscopic surgery in Peking University People＇ s Hospital from January 2010 to August 2011. Accessory ostium accounted for 2.4% （ 19/793 ） of the infertility patients receiving laparoscopic surgery in our center. Two surgical methods were adopted： close accessory ostium by means of pouch suture, and make an incision from the fimbria to accessory ostium. The endometriosis lesion found during the surgery was also removed by electrocoagulation. One to three doses of GnRH-a were given postoperatively to prevent the recurrence of endometriosis. Two patients had to use contraception method due to myomectomy. The other 17 patients were followed up for 12 - 19 months to analyze pregnancy rate, abortion rate and ongoing pregnancy rate. Results A total of 17 （89.5%） out of 19 patients with accessory ostium had endometriosis, including 88.2% （15/17） in r-AFS Stage I - ]]. Three cases were diagnosed as distal tubal adhesion by hysterosalpingography （HSG）. Postoperative pregnancy rate was 58.8% （ 10/17）, with no abortion or ectopic pregnancy. Conclusions Medical history and HSG are helpful for the diagnosis of accessory ostium, and the final diagnosis should be based on careful examination of the whole tube during laparoscopy, especial]y the distal part. Accessory ostium may have a close relationship with endometriosis and infertility.