宫腹腔镜联合检查在原因不明不孕症诊断和治疗中的临床价值

目的探讨宫腹腔镜联合检查在原因不明不孕症诊断和治疗中的重要性。方法回顾性分析2012年5月至2015年12月因原因不明不孕症在北京协和医院行宫腹腔镜联合检查的患者519例,宫腹腔镜联合检查寻找原因不明不孕症的病因。结果在519例原因不明不孕症患者中,宫腹腔镜联合检查未发现异常者占10.2%(53/519),发现盆腔异常者占89.8%(466/519);盆腔异常患者分别为72.4%(376/519)盆腔粘连合并子宫内膜异位症、12.3%(64/519)盆腔粘连、3.7%(19/519)子宫肌瘤或卵巢囊肿以及1.3%(7/519)子宫内膜息肉。宫腹腔镜联合检查后随访12~36个月,最终纳入386例患者统计术后自然妊娠情况,术后总自然妊娠率为53.9%(208/386),年龄≥35岁患者的自然妊娠率为29.8%(31/104)。结论临床诊断为原因不明不孕症的患者,应行宫腹腔镜联合检查,在宫腹腔镜联合检查下能更直观地发现不孕症的病因,并且可进行针对性的治疗,提高妊娠率。高龄患者术后自然妊娠率明显下降,尝试自然妊娠的时间不宜过长。

Clinical study of hysteroscopy combined with laparoscopy in the diagnosis and treatment of unexplained infertility

Objective To explore the importance of the diagnosis and treatment value of laparoscopy and hysteroscopy in patients with unexplained infertility.Methods A total of 519 cases diagnosed as unexplained infertility,received laparoscopy and hysteroscopy in Peking Union Medical College Hospital from May 2012 to December 2015.The causes of infertility were evaluated,and the subjects were followed up to observe the nature pregnancy rate.Results Among 519 unexplained infertility patients,pelvic abnormalities had been explored in 466(89.8%,466/519)cases.Pelvic endometriosis combined with adhesions,pelvic adhesion alone,uterine leiomyoma and uterine cavity polyp were 72.4%(376/519),12.3%(64/519),3.7%(19/519)and 1.3%(7/519)respectively.The total natural pregnancy rate within the 3 years of follow up was 53.9%(208/386),and the natural pregnancy rate was 29.8%(31/104)in patients aged 35 years and over.Conclusions The patients with clinical diagnosis of unexplained infertility should be examined by hysteroscopy and laparoscopy.Under the examination,the causes of infertility could be found more intuitively,and targeted treatment could be carried out to improve the pregnancy rate.The natural pregnancy rate of the elderly patients decrease obviously after operation,and the time of natural trying pregnancy should not be too long.