宫腔镜联合腹腔镜诊治输卵管性不孕167例分析

目的:探讨宫腹腔镜联合在诊治输卵管性不孕中的应用价值。方法:在子宫输卵管造影诊断为输卵管性不孕的167例患者的326条输卵管中,有312条提示异常,行宫腹腔镜联合手术,对比分析宫腹腔镜联合与子宫输卵管造影在诊断子宫输卵管性不孕中的价值及联合手术在治疗输卵管病变中的优势。结果:167例患者的312条异常输卵管中,正常164条占52.56%(164/312),通畅并形态欠佳4条占1.28%(4/312),部分通畅4条占1.28%(4/312),间质部阻塞48条占15.38%(48/312),伞端阻塞并积水92条占29.49%(92/312)。而提示正常的14条输卵管中,有2条虽全程通畅,但与周围组织有不同程度的黏连。子宫输卵管造影结果与宫腹腔镜联合手术结果相符的为160条输卵管,符合率49.08%(160/326)。以宫腹腔镜联合检查作为诊断输卵管异常的金标准,子宫输卵管造影的敏感性98.66%、特异性6.82%、阳性预测值47.44%、阴性预测值85.71%。经联合手术确诊的输卵管异常,均在同期麻醉下实施了相应手术治疗,无并发症发生。结论:宫腹腔镜联合检查是输卵管不孕直观准确的诊断方法,联合手术与诊断同期实施,安全、疗效好,是治疗输卵管病变的有效方法。

Analysis on 167 cases with salpingian infertility diagnosed and treated by hysteroscopy combined with laparoscopy

Objective:To explore the application value of hysteroscopy combined with laparoscopy in the diagnosis and treatment of salpingian infertility.Methods:312 fallopian tubes were found abnormity among 326 fallopian tubes from 160 cases with salpingian infertility,then were treated by hysteroscopy combined with laparoscopy,the data were compared and analyzed.Results:Among 312 abnormal fallopian tubes,164 fallopian tubes were normal (52.56%,164/312),4 fallopian tubes were unobstructed but poor modality (1.28%,4/312),48 fallopian tubes were interstitial tubal obstruction (15.38%,48/312),92 fallopian tubes were obstruction with hydrosalpinx (30.77%,96/312).Otherwise,2 of 14 normal fallopian tubes were unobstructed but adherence to periphery. The coincidence rate of hysterosalpingography and hysteroscopy combined with laparoscopy was 49.08% (160/326). Used the result of hysteroscopy combined with laparoscopy as golden standard,the sensitivity,specificity,positive predictive value and negative predictive value were 98.66%,6.82%,47.44% and 85.71%. No complications occured.Conclusion:Hysteroscopy combined with laparoscopy is a direct diagnostic method for salpingian infertility and a best way in the diagnosis and treatment of salpingian lesions.