腹腔镜与显微外科手术治疗输卵管伞端粘连闭锁伴不孕的疗效分析

目的:探讨腹腔镜与显微外科手术治疗输卵管伞端粘连闭锁合并不孕的临床效果及预后影响因素。方法:我院对136例患有输卵管伞端粘连合并不孕者施行手术治疗,其中腹腔镜手术85例(A组),显微外科手术51例(B组)。结果:A组总妊娠率35.08%(20/57),宫内妊娠率31.58%(18/57),B组总妊娠率28.13%(9/32),宫内妊娠率25%(8/32),两组无明显差异(P>0.05),根据输卵管病变伴盆腔粘连程度分为Ⅵ期:Ⅰ期患者的宫内妊娠率为A组50.00%(12/24)、B组30%(3/10);Ⅱ期患者的宫内妊娠率为A组42.86%(6/14)、B组25%(2/8);Ⅲ期患者的宫内妊娠率A组为0(0/11)、B组23.08%(3/13);Ⅳ期患者的宫内妊娠率两组均为0。结论:输卵管整形术后的妊娠率取决于输卵管的解剖形态与生理功能的状况以及盆腔粘连的性质和程度。Ⅰ、Ⅱ期患者术后宫内妊娠率,腹腔镜组高于显微外科组,但Ⅲ期患者的输卵管造口术,显微手术更有利于保护输卵管纤毛,恢复伞与卵巢的解剖关系和拾卵功能。对于Ⅳ期患者,确定输卵管功能已完全丧失,主张切除双侧输卵管,术后通过助孕技术获得妊娠。

Efficacy of Laparoscopy and Microsurgery for Infertile Women Adherent or Obstructed with Distal Tube

Objective: To evaluate the efficacy and affected factors of laparoscopy and microsurgery forinfertile women with adherent or obstructed distal tube . Method: Between January 1998 and Decemeber 2002 ,136women were treated by surgery for distal tube obstruction with infertility. Eighty-five were laparoscopy (group A),51 were microsurgery (group B). Results: Total pregnancies and intrauterine pregnancy rate were 35.08% (20/57)and 31.58%(18/57) in group A, 28.13%(9/32)and 25% (8/32)in group B with no significant difference (P>0.05).The patients were classified into four stages according to the extent of tubal distortion and degree of adnexaladhesions. Intrauterine pregnancy rate of stageⅠ,Ⅱ,Ⅲ and Ⅳ were 50%(12/24), 42.86%(6/14), 0(0/11), 0(0/8) in group A and 3%(3/10) ,25%(2/8), 23.08%(3/13), 0(0/1)in group B. Conclusions: The pregnancy successwas related to the extent of tubal distortion and degree of adnexal adhesions. Intrauterine pregnancies in stageⅠandⅡ were higher in group A than those in group B. Laparoscopy represents the first-choice treatment of distaltubal obstruction in stage ⅠandⅡ. In stage Ⅲ microsurgery shawed better results in restoring tubal ovariananatomy and function than laparoscopy. In stage Ⅳ salpingectomy IVF and is suggested.