经阴道注水腹腔镜联合宫腔镜检查不孕症的临床观察

目的探讨经阴道注水腹腔镜(THL)联合宫腔镜检查不孕症的临床效果和应用价值。方法对42例不孕症患者施行THL联合宫腔镜检查,其中原发性不孕(原发组)20例和继发性不孕(继发组)22例,观察患者的输卵管通畅性、盆腔病变情况,记录THL手术时间、术后离院时间、术后阴道壁穿刺孔愈合时间、穿刺成功率与术中及术后并发症。结果原发组术后输卵管双侧通畅12例,继发组术后输卵管双侧通畅4例,两组比较差异有显著性(P<0.05);原发组盆腔粘连5例,继发组盆腔粘连14例,两组比较差异有显著性(P<0.05);术后需要进一步施行常规腹腔镜手术的患者仅7例(7/42,16.6%);42例不孕症患者THL手术时间、术后离院时间和阴道壁穿刺孔愈合时间分别为(10.5±1.6)min、(88.3±13.5)min和(4.6±0.6)d;穿刺成功率为96%(42/44);无直肠损伤、术后穿刺部位出血、盆腔感染等并发症发生。结论 THL具有准确、微创、安全、经济、不需住院等优点,联合应用宫腔镜检查效果更佳;THL和宫腔镜联合检查可作为不孕症早期检查的一线方法。

Study on transvaginal hydrolaparoscopy combined with hysteroscopy in patients with infertility

Objective To evaluate the advantage of transvaginal hydrolaparoscopy(THL)combined with hysteroscopy in patients with infertility.Methods 20 primary infertile patients(primary group) and 22 secondary infertile patients(secondary group) were received THL(using a 3-mm scope with a 0°lens)and hysteroscopy.the fallopian tube patency,pelvic pathology,operative time,discharge time,healing time of vaginal wound,success rate of insertion into the pouch of Douglas and intra and postoperative complications were observed.Results Primary group had more tube patency cases(P<0.05) and fewer pelvic adhesion cases(P<0.05) when compared with secondary group.Only 16.6% patients needed conventional laparoscopy postoperatively.The time of THL,discharge time,and healing time of vaginal wound were respectively(10.5±1.6)min,(88.3±13.5)min and(4.6±0.6)d.No complications occurred.Conclusions THL is accurate,minimally invasive,safe,economical,and does not require hospitalization.It could serve as a first-line procedure in early investigation of infertility when combined with hysteroscopy.