经阴道注水腹腔镜联合宫腔镜检查不孕症的临床观察

Study on combined transvaginal hydrolaparoscopy and hysteroscopy in patients with infertility

目的 探讨经阴道注水腹腔镜(THL)联合官腔镜检查不孕症的临床效果和应用价值。方法 对46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)和继发性不孕(继发组)各23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、总手术时间、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13例,继发组术后输卵管双侧通畅5例;两组比较,差异有显著性(P<0.05);原发组盆腔粘连6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(7/46,15％);46例不孕症患者THL手术时间、总手术时间、术后离院时间和阴道壁穿刺孔愈合时间分别为(10.5±1.7)min、(32.2±4.6)min、(87.3±12.5)min和(4.5±0.5)d;穿刺成功率为96％(46/48);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。

Objective To evaluate the advantages of combined transvaginal hydrolaparoscopy (THL) and hysteroscopy in patients with infertility. Methods Twenty-three primary infertile patients (primary group) and 23 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 15% patients needed conventional laparoscopy postoperatively. The time of THL, overall time of operation, discharge time, and healing time of vaginal wound were respectively (10. 5 ± 1.7) min, (32. 2 ± 4. 6) min, (87.3 ±12.5) min, and (4.5 ±0.5) days. 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 stages of infertility investigation when combined with hysteroscopy.