输卵管性不育及输卵管病变的腹腔镜诊断

LaparoscopicDiagnosisofTubalInfertilityandFalopianTubeLesions

目的：探讨应用腹腔镜对输卵管性不育的诊断价值。方法：于腹腔镜下对１１２０例输卵管性不育患者的盆腔进行观察，并通过输卵管通液，观察输卵管病变。结果：输卵管性不育患者占不育患者的３２．８％。１１２０例中，盆腔结核为６３．６％，非特异性盆腔炎（盆腔炎）为３６．４％（Ｐ＜０．０１）。盆腔结核中，输卵管完全梗阻为８１．２％；盆腔炎中，输卵管完全梗阻为７０．７％（Ｐ＜０．０１）。盆腔结核患者的盆腔病变较盆腔炎明显，分为粟粒腹水型（９．４％）、粘连包块型（３５．８％）、粘连钙化型（４３．１％）及结节硬化型（１１．７％）。输卵管外观正常者为２９．９％，其余为轻度粘连及积水。结论：对不育患者应用腹腔镜检查有一定价值；根据腹腔镜下观察的病变，并结合病理检查，可做出正确诊断。

Objective:Toanalysethediagnosticvalueoflaparoscopyinpatientswithtubalinfer-tility.Methods:Themorphologicalappearanceoffalopiantubesandsurroundingtissuesof1120caseswithproventubalinfertilitywereobservedunderlaparoscopy.Hydrotubationwasperformedatthesametimeineachcase.Results:Tubalinfertilitydiagnosedbylaparoscopyaccountedfor32.8%ofinfertilepatients.Amongthem,pelvictuberculosisocupied63.6%,whilenonspecificinflamma-torydisease(NSID)36.4%.44.8%ofthetuberculosisand62.2%ofNSIDgrouphadnegativefin-dingsduringpelvicexamination.Fourtypesoftuberculosislesionsweredemonstrated:miliaryascites(9.4%),adherentmass(35.8%),adhesionandcalcification(43.1%),nodularsclerosis(11.7%).IntheNSIDgroup,simpletubalobstructionacountedfor29.9%,theremainingweremildadhesionorhydrosalphinx.Completetubalocclusionoccupied81.2%intuberculosisgroupand70.7%inNSIDcases.Inthetuberculosisgroupthepositiverateofpelviclesionbiopsyandendome-trialbiopsywasonly59.1%and20.5%respectively.Conclusion:Laparoscopyexaminationisavaluableprocedurefortheetiologicaldiagnosisoftubalinfertility.