微型腹腔镜与宫腔镜联合检查在不孕症诊治中的应用

The Combination Use of Minilaparoscopy and Hysteroscopy in Infertile Patients

目的 探讨微型腹腔镜与宫腔镜联合检查对不孕症的诊治效果。 方法 对 5 3例原发性不孕症 (原发组 )及 79例继发性不孕症 (继发组 )患者施行微型腹腔镜与宫腔镜联合手术 ,观察患者的腹腔与宫腔病理、宫腔镜下输卵管口插管通液情况及并发症。 结果 盆腔粘连、输卵管因素、子宫内膜异位症、多囊卵巢综合征、慢性宫内膜炎、宫内膜息肉是不孕症常见病因。术后输卵管双侧通畅、通而不畅或一侧通畅、双侧阻塞的病例 ,原发组分别为 35 .8%、4 7.2 %、17.0 % ,继发组分别为 35 .4 %、4 1.8%、2 2 .8%。两组术后输卵管通畅病例均较术前明显增加 (P <0 .0 1)。术中术后无并发症发生。结论 微型腹腔镜与宫腔镜联合检查能优势互补 ,大大提高不孕症的诊治效果 。

Objective To evaluate the advantages of combining minilaparoscopy and hysteroscopy in the diagnosis and treatments of infertile patients. Methods 53 primary infertile patients (primary infertility group) and 79 secondary infertile patients (secondary infertility group) were performed minilaparoscopy (using a 3-mm scope with 0° lens) and hysteroscopy. The pathology of pelvis and uterine cavity, the conditions of chromotubation underwent by catheterism with hysteroscopic guidance and the complications of both groups were observed. Results The pelvic adhesion, fallopian tubes pathology, endometriosis, PCOS, endometritis and endometrial polyp were the common causes of infertility. After operation, the rates of bilateral tubal patency, partial obstruction or unilateral tubal patency, and the total obstruction in primary infertility group was 35.8%, 47.2%, and 17.0% respectively. The rates in secondary infertility group was 35.4%, 41.8%, and 22.8% respectively. The rates of tubal patency of both groups increased after the procedure (P<0.01). No complications occurred. Conclusions Combining minilaparoscopy and hysteroscopy can increase the diagnostic and therapeutic rates for the infertile patients with less trauma.