宫、腹腔镜联合诊治输卵管性不孕102例分析

目的探讨宫腔镜联合腹腔镜对输卵管性不孕的诊断及治疗效果。方法 2005年2月~2008年2月,对腹腔镜监视下通液证实的输卵管梗阻性不孕患者102例,行腹腔镜下盆腔粘连分解、输卵管造口成形术以及宫腔镜联合腹腔镜输卵管插管复通手术。结果 102例203条输卵管中,远段不通145条,经粘连分解及伞端造口后复通72条,输卵管插管复通31条,共复通103条,复通率71.0%(103/145);58条近中段梗阻输卵管经分解粘连仅8条复通,输卵管插管复通26条,共复通34条,复通率58.6%(34/58)。复通失败的66条输卵管中病理证实为陈旧性结核病变36条(36/66,54.5%),其中30条为原发不孕患者,复通成功的输卵管仅2条为结核(2/137,1.5%),且为早期,通畅情况均为通而不畅。复通术后2年的62例中宫内妊娠24例(38.7%),输卵管妊娠4例(6.5%)。其中23例(23/28,82.1%)于术后3~12个月妊娠。结论腹腔镜下盆腔粘连分解、输卵管造口成形以及宫、腹腔镜联合输卵管插管复通是治疗输卵管梗阻性不孕的有效方法;输卵管结核是本地区妇女原发性输卵管性不孕的重要因素,治疗效果极差。

Analysis of 102 Cases with Tubal Infertility Diagnosed and Treated by Hysteroscopy Combined with Laparoscopy

Objective To explore the efficacy of hysteroscopy combined with laparoscopy in the diagnosis and treatment of tubal infertility. Methods From February 2005 to August 2008,totally 102 cases of patients with obstructive tubal infertility were diagnosed after hydrotubation under the guidance by laparoscopy,adhesiolysis of perisalpingoovaritis,dilation of the fallopian tube and salpingostomy were then performed immediately.Meanwhile,intubation and recanalization were carried out by means of laparoscopy combined with hysteroscopy.Results Totally 203 fallopian tubes were examined in the 102 patients,among which 145 showed distal obstruction,and 58 were proximal midpiece obstruction.After salpingo-ovariolysis and salpingostomy,72 of the distal obstruction tubes were recanalized,while the other 31 tubes were recanalized after intubation,the rate of recanalization was 71.0%（103/145）.In the 58 fallopian tubes with proximal midpiece obstruction,only 8 were recanalized after salpingo-ovariolysis,and the other 26 tubes were recanalized after intubation,the recanalization rate was 58.6%（34/58）.Recanalization was failed in totally 66 fallopian tubes,of which pathological examination showed obsolete tuberculosis in 36 tubes（54.5%,30 of them were diagnosed with primary infertility）.In all the tubes with tuberculosis,recanalization was completed only in 2 cases（2/137,1.5%）;both the cases were at the early stage of tuberculosis;and both were partially recanalized after the procedure.After the recanalization,24 patients（38.7%,24/62） achieved uterine pregnancy in 2 years,while 4 patients（6.5%,4/62） had tubal pregnancy;of these women,23 cases got pregnant in 3 to 12 months after the procedure. Conclusions It is an effective approach to treat oviductal obstruction by using salpingo-ovariolysis and salpingostomy under the guidance by laparoscopy,as an alternative of intubation and recanalization by means of laparoscopy combined with hysteroscopy.Obsolete tuberculosis is a major cause of tubal infertility in our local region,which is a refractory episode.