摘要
目的探讨宫腔镜联合腹腔镜治疗输卵管性不孕的诊断及治疗价值。方法回顾性分析2016年12月至2018年4月因输卵管性不孕患者应用宫腹腔镜联合治疗的临床资料及妊娠随访结局。结果子宫输卵管碘油造影(HSG)和宫腹腔镜联合探查在诊断输卵管通畅性方面具有较好的一致性,HSG诊断输卵管通畅性的灵敏度为69.0%,特异度91.0%,假阴性率31.0%,假阳性率8.9%,Kappa值为0.607(P<0.01);宫腹腔镜联合行输卵管插管通液术对输卵管间质部梗阻的复通率为82.71%(67/81),对峡部和壶腹部的复通率为69.84%(44/63),对伞端积水的复通率为100%,对输卵管通而不畅的改善率为74.64%(53/71);输卵管性不孕患者中有18.45%的患者合并盆腔子宫内膜异位症;术后24个月妊娠率为32.6%(45/138),术后3个月至半年妊娠率最高。结论宫腹腔镜联合手术可以提高输卵管不孕患者的自然妊娠率,同时可以改善患者盆腔内环境及子宫内膜容受性,从而提高患者的辅助生育治疗效果,对于输卵管性不孕的患者,可作为体外授精(IVF)的替代方案。
Objective To explore the diagnosis and treatment effect of hysteroscopy combined with laparoscopy in tubal infertility.Methods The clinical data of tubal infertility patients who admitted to our hospital from December 2016 to April 2018 who received treatment with hysteroscopy combined with laparoscopy surgery were retrospectively analyzed and pregnancy outcome.Results Hysteroslpingography(HSG)and laparoscopy combined with hysteroscopy exploration had a good consistency in the diagnosis of tubal patency.The HSG diagnosis sensitivity of fallopian tube patency was 69.0%,the specificity was 91.01%,The false negative rate was 31.0%,The false positive rate was 8.9% and the Kappa value was 0.607(P<0.01).The recanalization rate of tubal interstitial obstruction was 82.71%(67/81),The re-opening rate of tubal isthmus and ampulla was 69.84%(44/63).The reentry rate of hydrosalpinx at the umbrella end of the oviduct was 100%,The improvement rate of fallopian tube poor pass was 74.64%(53/71).Among the patients with tubal infertility, 18.45% of the patients had pelvic endometriosis, the pregnancy rate at 24 months after surgery was 32.6%(45/138). The pregnancy rate was highest from 3 months to 6 months after the operation.Conclusion Hysteroscopy combined with laparoscopy surgery can improve the natural pregnancy rate of patients with tubal infertility.At the same time, hysteroscopy combined with laparoscopy surgery can effectively solve hydrosalpinx, pelvic endometriosis, pelvic adhesion and other conditions, which will improve the patient endometrial receptivity, so as to improve the effect of assisted fertility treatment,the produces should be considered as an alternative to In Vitro Fertilization(IVF) for women with only tubal infertility.
作者
和晓利
张宁
李雅丽
魏利
李睿
HE Xiao-li;ZHANG Ning;LI Ya-li;WEI Li;LI Rui(Department Gynecology,Henan Provincial People’s Hospital,People’s Hospital of Zhengzhou University,People’s Hospital of Henan University,Zhengzhou,450003,China)
出处
《医药论坛杂志》
2020年第4期1-4,共4页
Journal of Medical Forum
基金
河南省医学科技攻关计划项目(2018020423)。
关键词
子宫输卵管造影
输卵管性不孕
宫腹腔镜联合
诊断
Hyserosalpingograph
Tubal infertility
Hysteroscopy combined with laparoscopy surgery
Diagnosis
