宫腹腔镜直视下插管治疗输卵管阻塞性不孕疗效分析

目的:探讨腹腔镜联合宫腔镜直视下插管疏通治疗输卵管阻塞性不孕的临床价值。方法:2009年1月～2011年1月对65例经子宫输卵管造影(hysterosalpingography,HSG)提示输卵管阻塞的不孕症患者,经腹腔镜检查确诊后对输卵管远端阻塞或积水及相应盆腔病变进行手术治疗同时在宫腔镜直视下对近端阻塞输卵管用导丝疏通治疗。结果:65例患者中经腹腔镜检查确诊有97条输卵管阻塞,其中34条近端阻塞,50条远端积水或伞端闭锁,13条近端及远端同时阻塞;手术输卵管疏通治疗后通畅92条,其中2条行输卵管吻合术。术后半年发现9例输卵管再次阻塞,半年内异位妊娠3例。结论:宫腹腔镜联合直视下导丝疏通是治疗输卵管阻塞性不孕的理想安全治疗手段,防止术后狭窄阻塞需要进一步探讨。

Analysis of therapeutic effect of wire-guided tubal deoppilation under hysteroscopic and laparoscopic monitoring for the treatment of occluded oviduct infertility

Objective:To investigate the clinical significance of wire-guided tubal deoppilation under hysteroscopic and laparoscopic monitoring for the treatment of occluded oviduct infertility.Methods:A total of 65 cases of infernality were diagnosed of oviduct obstruction by hysterosalpingography(HSG),they underwent laparoscopic exploration to clarifying the diagnosis and received related operation according to their pelvic lesions,wire guided tubal deoppilation was conducted under hysteroscopic supervision combined with laparoscope for the treatment of proximal oviduct obstruction.Results:0ut of the 65 cases,97 oviducts were involved of which,34 were pmximaily occluded,50 were distally occluded or blinded,and 13 were proximallv and distally occluded.After the surgery,92 oviducts were unobstructed,2 got tubal anastomosis.There were 9 cases were reexamined with HSG and revealed obstructed with 6 months postoperatively and 3 cases unfortunately got ectopic pregnancy.Conclusion:Wire-guided tubal recanalization under hysteroscopy and 1aparoscope supervision is an ideal option for the treatment of occluded oviduct infertility,but how to prevent postoperative oviduct narrow and obstruction still needs further exploration.