阴道注水腹腔镜与不同方法对不孕症诊断价值的临床比较

Clinical comparison of transvaginal hydrolaparoscopy with different methods in infertile patients

目的比较子宫输卵管造影(hysterosalpingography,HSG)、标准腹腔镜(laparoscopy,LAP)及阴道注水腹腔镜(transvaginalhydrolaparoscopy,THL)在输卵管性不孕上的诊断价值。方法分别采用子宫输卵管造影、阴道注水腹腔镜及标准腹腔镜检查输卵管性不孕58例,将观察结果进行比较。结果HSG与LAP比较手术时间短,平均所需费用低,诊断符合率为65.52%(38/58),差异有显著性。THL与LAP比较手术时间短,平均所需费用低,诊断符合率为94.83%(55/58)。平均所需费用HSG最低,LAP为最高,三者两两比较,差异有显著性。结论子宫输卵管造影虽简单、经济,但准确性不理想,标准腹腔镜具有准确、微创的优点,但存在费用较高、需要住院、需要接受全身麻醉等缺点,阴道注水腹腔镜是一种既准确、微创,又简单、安全、快速、经济、不需住院和全身麻醉的全新方法,可作为不孕症早期检查的常规方法。

[Objective] To compare the value and feasibility and usefulness of Transvaginal hydrolaparoscopy （THL） as a screening tool in infertile patients with standard diagnostic laparoscopy and hystorsatpingography. [Methods] We adopted three methods to perform on 58 infertile women, then compared with the results of observation. [Results] HSG diagnosis was correlated with that of laparoscopy in 65.52% （38/58）, with statistically significandy difference （P 〈0.01）. THL diagnosis was correlated with that of laparoscopy in 94.83%（55/58） of cases, with no differences between the two methods （P 〉0.05）. The average operation time was short in HSG. It was the longest in LAP. The average cost of operation was the lowest in HSG, but it was the most in LAP. [Conclusions] Although HSG is simple and economical, the accuracy is poor. Standard diagnostic laparoscopy is considered the gold standard to investigate tube-peritoneal infertility, while it requires general anaesthesia and full operative facilities. THL can be performed on an outpatient basis under local anaesthesia. It is a highly accurate technique in comparison with the laparoscopy. The results of our study indicate that THL is a valuable technique for the diagnosis of tubal pathology in cases of abnormal findings or incomplete evaluation.