输卵管积水的不孕症患者宫腹腔镜术后生育结局分析

目的探讨宫腹腔镜联合手术对输卵管积水不孕症患者生育功能的改善情况。方法收集2008年7月至2010年6月接受宫腹腔镜联合手术的82例输卵管性不孕症患者的临床资料，剔除了3例因双侧输卵管近段梗阻建议行体外受精一胚胎移植（IVF-ET）后，最后共79例人组本研究。根据输卵管积水与否分为：输卵管积水组（42例）和非积水组（37例），随访2年，比较两组妊娠结局。结果总的宫内妊娠率为41．8％，其中积水组为31．O％（13／42），非积水组为54．1％（20／37），两组比较差异有统计学意义（P〈0．05）；积水组异位妊娠5例，流产3例，非积水组异位妊娠1例，流产1例，差异无统计学意义（P〉0．05）。且妊娠率随积水程度加重而下降。结论输卵管积水影响不孕症患者宫腹腔镜术后生育结局，Ⅲ一Ⅳ期患者妊娠率明显降低，宫腹腔镜联合手术对其生育能力的改善有限。

The impact of hydrosaipinx on reproductive outcome post treatment of hysteroscopy combined with laparos-copy surgery in infertility patients

Objective To investigate the improvement of reproductive function after hysteroscopy integrated with aparoseopy operation for treating infertility in tubal infertility patients with hydrosalpinx. Methods The clinical data of 82 cases of tubal infertility patients accepted hysteroscopy combined with laparoscopy operation during July 2008 to June 2010 were recruited, and 79 cases were enrolled in present study at last after excluding 3 cases who were suggested to do in vitro fertilization and embryo transfer （IVF-ET） because of the bilateral proximal tubal obstruction. According to presence or absence of hydrosalpinx, 79 enrollment cases were divided into two groups： hydrosalpinx group （ n = 42 ） and non-hydrosalpinx group （ n = 37 ）. The followed-up period was two years, and the pregnancy outcomes in two groups were compared. Results The total intrauterine gestation rate was 41.8%, while the intrauterine gestation rate in hydrosalpinx group was significantly lower than that in non-hydrosalpinx group 31.0% （ 13/42 ） vs 54.1% （ 20/37 ）, P 〈 0.05 ]. There were 5 cases of ectopic pregnancy and 3 cases of abortion in hydrosalpinx group, while only 1 case of ectopic pregnancy and 1 case of abortion in non-hydrosalpinx group, but there was no significant difference in two groups （ P 〉 0.05 ）. The gestation rate decreases with aggravating of hydro- salpinx degree. Conclusions Hydrosalpinx could influence fertility outcome after treatment of bysteroscopy combined with laparoscopy surgery in infertility patients. The pregnancy rate significantly lowers in infertility patients with III-IV stage of hydrosalpinx, and the hysteroscopy combined with aparoseopy operation has poor treatment effect to these patients.