宫、腹腔镜下微导丝疏通在输卵管阻塞性不孕中的应用

Application of wire-guided tubal recanalization under hysteroscope combined with laparoscope for the treatment of occluded oviduct infertility

目的探讨腹腔镜联合官腔镜下微导丝疏通治疗输卵管阻塞性不孕的临床价值。方法2001年2月-2004年12月，我们对63例经子宫输卵管造影（hysterosalpingography，HSG）提示双侧输卵管阻塞，且至少有一侧近端阻塞的不孕症者，术中先行腹腔镜和宫腔通液检查确诊并治疗相应盆腔病变，继之在腹腔镜和官腔镜监视下对输卵管近端阻塞用微导丝疏通治疗。结果63例中有118条输卵管阻塞（输卵管切除8条），其中59条近端阻塞，45条远端积水或呈盲端，14条近端及远端同时阻塞；手术输卵管疏通治疗后通畅99条。术后1年内宫内妊娠23例，妊娠率36．6％。术后1年未孕25例行HSG检查，发现7例输卵管再次阻塞。结论宫、腹腔镜联合下微导丝疏通是治疗输卵管阻塞性不孕较理想的治疗手段。

Objective To investigate the clinical value of wire-guided tubal recanalization under hysteroscope combined with laparoscope for the treatment of occluded oviduct infertility. Methods A total of 63 cases of infertility were diagnosed by hysterosalpingography （HSG） as having bilateral oviduct obstruction, of which at least one side of oviduct was proximally occluded. After laparoscopic exploration and hysteroscopic hydrotubation were performed for clarifying the diagnosis and managing related pelvic lesions, wire-guided tubal recanalization was conducted under hysteroscope combined with laparoscope for the treatment of proximal oviduct obstruction. Results Out of the 63 cases, a total of 118 oviducts were involved （ eight oviducts had been previously resected）. Of the 118 oviducts, 59 were proximally occluded, 45 were distally occluded or blinded, and 14 were proximally and distally occluded. After the surgery 99 oviducts were unobstructed. Intrauterine pregnancy was obtained within 1 year in 23 cases （36.6%）. There were 25 cases of unpregnancy within 1 year, which were re-examined with HSG, presenting a re-obstruction in 7 cases. Conclusions Wire-guided tubal recanalization under hysteroscope combined with laparoscope is an ideal option for the treatment of occluded oviduct infertility.