阴道注水腹腔镜对不孕症诊断价值的临床探讨

Clinical Study on Transvaginal Hydrolaparoscopy for the Diagnostic Evaluation of Infertile Patients

目的比较子宫输卵管造影(hysterosalpingography,HSG),标准腹腔镜(standard diagnostic laparoscopy,LAP)及阴道注水腹腔镜(Transvaginal hydrolaparoscopy,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检查输卵管性不孕28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64.29%(18/28),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92.86%(26/28),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,但存在需要住院和全身麻醉等缺点;阴道注水腹腔镜具有准确、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 explore the value and feasibility and usefulness of transvaginal hydrolaparoscopy（THL）as a screening tool for infertile patients with Standarddiagnostic laparoscopy （LAP）and hysterosalpingography（HSG）. Methods The 3 above methods were used in 29 infertile women,then the results of observation for the 3 methods were compared. Results Compared to LAP and HSG both needed less time of operation and less cost with statistically significantly difference, and their diagnostic rates were 64.29%（18/28 cases）and 92. 86% （26/28 cases）, respectively. The average cost of operation was the lowest in HSG,while was the highst in LAP. Conclusion Although HSG is simple and economical, the accuracy is poor. Standard diagnostic laparoscopy is considered the gold standard to investigate tubo-peritoneal infertility, while it requires general anaesthesia and full operative facilities. THL can be performed on the outpatients under local anaesthesia and is a highly accurate technique in comparison with the laparoscopy. Therefore THL may be a valuable technique for the diagnosis of tubal pathology.