腹腔镜下输卵管状态评级对不孕症治疗方式及预后影响探讨

目的:探讨腹腔镜下输卵管状态评级对不孕症治疗方式及预后影响。方法:选择2010年6月～2011年6月在该院生殖中心因输卵管远端阻塞性不孕行腹腔镜手术95例,术中对输卵管病变分级。依据术中评级结果选择输卵管造口术或输卵管造口术+输卵管根部灼断术,术后比较不同级别输卵管妊娠情况及不同治疗方式治疗后妊娠情况。结果:严格按照评级标准评级后发现95例患者中Ⅰ级11例;Ⅱ级25例;Ⅲ级26例;Ⅳ级33例,评为IV级33例中经再次向家属交代病情后行输卵管根部灼断18例,随访期内,术后妊娠率分别为I级45.45%(5/11)、Ⅱ级36.00%(9/25)、Ⅲ级7.69%(2/26),Ⅳ级0.00%(0/33)。Ⅰ级、Ⅱ级妊娠率明显高于Ⅲ级、Ⅳ级,两者之间差异有统计学意义(P<0.05)。同时Ⅲ级、Ⅳ级中有16例试孕6～13月后行助孕治疗,妊娠5例,妊娠率31.25%;输卵管根部灼断术后18例进入助孕周期治疗12例,妊娠7例,妊娠率58.33%,两者之间差异有统计学意义(P<0.05)。结论:对远端阻塞性输卵管进行腹腔镜手术治疗的病例,应于术中进行输卵管状态评级,根据评级结果,选择不同的治疗方式。

Discussion on the effect of laparoscopic grading of Fallopian tubes on therapeutic methods and prognosis of patients with infertility

Objective:To explore the effect of laparoscopic grading of Fallopian tubes on therapeutic methods and prognosis of patients with infertility.Methods:A total of 95 patients with infertility caused by distal tubal obstruction who underwent laparoscopic surgery in the hospital from June 2010 to June 2011 were selected,grading of Fallopian tubes was performed during surgery.Salpingostomy or salpingostomy combined with burn out at near-end Fallopian tube was selected according to intraoperative grading results of Fallopian tubes;after surgery,the pregnancy situations of patients with different grades of Fallopian tubes and different therapeutic methods were compared.Results:According to grading criteria of Fallopian tubes,among 95 patients,11 patients of grade Ⅰ,25 patients of grade Ⅱ,26 patients of grade Ⅲ,and 33 patients of grade Ⅳ were found;among 33 patients of grade Ⅳ,18 patients underwent burn out at near-end Fallopian tube after explaining the situations to family members again,during follow-up,the pregnancy rates of patients of grade Ⅰ,grade Ⅱ,grade Ⅲ,and grade Ⅳ were 45.45%(5/11),36.00%(9/25),7.69%(2/26),and 0.00%(0/33),respectively.The pregnancy rates of patients of grade Ⅰ and grade Ⅱ were statistically significantly higher than those of patients of grade Ⅲ and grade Ⅳ(P<0.05).Among the patients of grade Ⅲ and grade Ⅳ,16 patients underwent assisted reproduction therapy after 6-13 months,5 patients got pregnancy,the pregnancy rate was 31.25%;among 18 patients undergoing burn out at near-end Fallopian tube,12 patients entered into assisted reproduction therapy,7 patients got pregnancy,the pregnancy rate was 58.33%,there was statistically significant difference between them(P<0.05).Conclusion:For the patients with infertility caused by distal tubal obstruction undergoing laparoscopic surgery,grading of Fallopian tubes should be performed during surgery,then different therapeutic methods are selected according to the results.