腹腔镜下输卵管分级在输卵管性不育中的应用

目的　探讨腹腔镜对输卵管性不育的诊断与治疗意义。　方法　回顾性分析 2 0 0 1年 5月至 2 0 0 2年 12月应用腹腔镜手术治疗的 178例输卵管性不育患者临床资料。在腹腔镜下按输卵管病变外周粘连情况 ,有无其他合并症等不同程度分 4级 ,比较不育年限与输卵管分级的关系 ,随访不同级患者手术结果。　结果　输卵管分级随不育年限增加而逐渐增加的趋势。术后宫内妊娠率与输卵管分级明显相关 ,输卵管分级I、II、III、IV级的宫内妊娠率分别为 5 6 .2 %、19.8%、10 .3%及 0 ;IV级者体外受精 胚胎移植后的宫外孕发生率较高 ,但经输卵管近端结扎后再行体外受精 胚胎移植可明显减少宫外孕的发生。　结论　腹腔镜下输卵管分级可评价输卵管损害的严重程度和整形术的预后。

The grading of fallopian tube with laparoscopy for the treatment of tubal infertility

Objective: To evaluate the clinical benefit of laparoscopy in the diagnosis and treatment for the tubal infertility. Methods:One hundred and seventy-eight infertile women who underwent the laparoscopy from May 2001 to December 2003 were analyzsed retrospectively. Their tubes were classified into four grades according to the degree of the oviduct patency, the macroscopic aspect of endosalpinx, the thickness of the tubal wall, the nature and extent of adhesions and other complications. The correlation between infertile period and tubal grades were analyzed and the postoperative pregnancy outcomes were in follow up. Results: There was a significant association between infertile period and tubal grade. The postoperative pregnancy rate was significantly related to the tubal grade. The intrauterine pregnancy rate was 56.2% (Grade I), 19.8% (Grade II), 10.3% (Grade III) and 0 (Grade IV), respectively. For those of Grade IV, the ectopic pregnancy rate was higher when they received IVF-ET treatment. But if the salpingectomy was performed before IVF-ET, the ectopic pregnancy rate was reduced. 、 Conclusion: The tubal grades assessed by laparoscopy can represent the degree of tubal damage and indicate the prognosis of the neosalpingostomy.