腹腔镜在改善输卵管不孕因素中的作用

Laparoscopy in the Treatment of Infertility Caused by Fallopian Tube Lesions

目的探讨腹腔镜在改善输卵管不孕因素中的作用.方法对145例不孕症患者应用腹腔镜检查,明确盆腔病变所致的病因并同时予以相应的手术治疗.结果不孕症盆腔病理改变表现为输卵管及周围组织或输卵管积水的盆腔粘连共123例,占84.8%,其中86例为慢性盆腔炎,造成输卵管近端阻塞38例,占44.2%(38/86),远端阻塞38例,占44.2%(38/86),全程阻塞10例,占11.6%(10/86);37例为盆腔子宫内膜异位症,造成输卵管近端阻塞30例,占81.1%(30/37),远端阻塞7例,占18.9%(7/37).经腹腔镜手术治疗,慢性盆腔炎所致的双侧输卵管阻塞由65.1%下降至20.9%;盆腔子宫内膜异位症所致的双侧输卵管阻塞由24.3%下降至8.1%.结论腹腔镜能明确盆腔不孕症病因,明确输卵管病变部位及程度,进行针对性手术治疗,恢复盆腔正常解剖结构,改善输卵管功能,对今后治疗提供科学的依据,从而尽快恢复不孕症患者生育能力.

Objective To evaluate the efficacy of laparoscopy in the treatment of infertility caused by fallopian tube lesions. Methods Laparoscopy was performed in 145 cases of infertility patients to define the etiology, and appropriate operative procedures were adopted at the same time. Results Pelvic adhesions existed in 123 patients, which accounted for 84. 8% of all the cases. Among them, chronic pelvic inflammatory diseases were found in 86 patients, causing proximal tubal obstruction （38/86, 44. 2% ）, distal tubal obstruction （38/ 86, 44. 2% ） , and total tubal obstruction （ 10/86, 11.6% ） Pelvic endometriosis were found in 37 cases, causing proximal tubal obstruction （30/37, 81.1% ）, and distal tubal obstruction （7/37, 18.9% ） . After laparoscopic operations, tubal obstructions resulting from chronic pelvic inflammatory diseases decreased from 65.1% to 20. 9% , while tubal obstructions resulting from pelvic endometriosis decreased from 24.3% to 8. 1% . Conclusion Pelvic lesions （ especially tubal lesions ） can be identified through laparoscopy in the treatment of infertility. Appropriate operative procedures may help to recover the normal anatomic structures in the pelvis so as to recover the fertility of the patients.