生育镜在不孕症诊治中的应用

目的探讨生育镜用于不孕症诊治的价值。方法用生育镜包括经阴道注水腹腔镜（THL）与宫腔镜]对115例不孕症患者进行盆腔检查,观察内容包括输卵管通畅性、盆腔粘连情况等,以及盆腔完全评价率（即盆腔器官是否能被生育镜全部观察到）及术中、术后并发症。同时行THL下输卵管通液术和宫腔镜下输卵管口插管通液术。穿刺套管针成功从后穹窿穿刺入子宫直肠陷凹110例,其中原发性不孕（原发组）49例,继发性不孕（继发组）61例。既往输卵管检查为双侧阻塞者,原发组21例,继发组22例。结果术后输卵管双侧或一侧通畅者原发组34例（69．4％,34／49）,继发组42例（68．9％,42／61）,两组比较,差异也无统计学意义（P〉0．05）;既往输卵管检查为双侧阻塞者,术后双侧或一侧输卵管通畅者原发组10例（47．6％,10／21）,继发组11例（50．0％,11／22）,两组比较,差异无统计学意义（P〉0．05）。盆腔粘连者原发组21例（42．9％,21／49）,继发组37例（60．7％,37／61）,两组比较,差异无统计学意义（P〉0．05）。两组总的盆腔完全评价率为69．1％（76／110）,其中原发组为77．6％（38／49）,继发组为62．3％（38／61）．两组比较,差异无统计学意义（P〉0．05）。术后需行常规腹腔镜手术者20例（18．2％,20／110）,原发组与继发组分别为4例（8．2％,4／49）和16例（26．2％,16／61）,两组比较,差异有统计学意义（P〈0．05）;其中17例接受了微型腹腔镜手术。术中无盆腔脏器损伤、出血、直肠损伤或穿孔,术后无穿刺部位出血及盆腔感染等并发症发生。结论生育镜用于不孕症的诊治,操作简单、微创、安全、患者依从性好;对于临床或超声检查均无明显盆腔疾病证据的不孕症患者,生育镜可以取代经腹腹腔镜,成为一步到位的盆腔检查方法。

Application of fertiloscopy in infertile women

Objective To investigate the advantages of fertiloscopy in the examination and therapy of infertile women.Methods One hundred and fifteen infertile patients underwent fertiloscopy including transvaginal hydrolaparoscopy(THL),conventional dye-test,hysteroscopy,and dye-test using catheterization of the tubal ostium by hysteroscopy from May 2003 to Mar 2005.Access to the pouch of Douglas was achieved in 110 patients(95.7%).The primary infertile patients(primary group) and secondary infertile patients(secondary group) included respectively 49 and 61 cases.The patients of tubal occlusion in two groups were respectively 21 and 22 cases preoperatively.The fallopian tube patency, pelvic adhesions,complete evaluation(all pelvic organs seen) or not,and intra-and postoperative complications were observed.Results There was no significant difference in the percentage of uni-and bilateral tubal patency cases between two groups postoperatively(69.4%,34/49 vs 68.9%,42/61)(P>0.05).Of the cases that were bilateral tubal occlusion in both groups preoperatively,the uni-and bilateral tubal patency cases accounted for respectively 47.6%(10/21) and 50.0%(11/22)(P>0.05) postoperatively.There was no significant difference in the percentage of pelvic adhesions cases between two groups(42.9%,21/49 vs 60.7%,37/61;P>0.05).The overall complete evaluation rate of pelvic organs was 69.1%(76/110),the rates of both groups were respectively 77.6%(38/49) and 62.3%(38/61,P>0.05).The rate of additional transabdominal operative laparoscopy was 18.2%(20/110) after fertiloscopy,of which,the rate of primary group was only 8.2%(4/49),much less than that of secondary group(26.2%,16/61;(P<)0.05).Seventeen women underwent transabdominal operative minilaparoscopy after fertiloscopy.No complications including pelvic organ injury,rectum perforation,intra-and postoperative bleeding,and postoperative pelvic inflammation occurred.Conclusions THL is simple,convenient,and complicationfree for the infertile women.Fertiloscopy could be used as a first-line and one-stop procedure in the pelvic assessment of infertile women without clinical or ultrasound evidence of pelvic disease instead of transabdominal laparoscopy. Transabdominal laparoscopy should be only used as a complementary procedure after fertiloscopy.