妇科内镜与放射介入治疗268例输卵管不同部位阻塞性不孕的结局比较

Gynecological endoscope and radio-intervention treatment outcome in 268 cases of infertility caused by fallopian tube obstruction in different portion

目的通过分析268例不同部位阻塞性不孕疏通的治疗结局,比较妇科内镜及放射介入的效果。方法268例输卵管阻塞性不孕患者分为2组,经妇科内镜疏通138例(内镜组)、放射介入疏通130例(介入组),根据HSG影像或腹腔镜诊断将输卵管阻塞分为4型:近端阻塞型(A型),中远端阻塞型(B),输卵管积水型(C型),输卵管和周围组织粘连、伞端闭锁型(D型)。2组实施输卵管疏通术并术后综合性抗炎治疗3个月,随诊1年,比较2组同型阻塞之间的正常妊娠、输卵管妊娠、再阻塞情况。结果2组中同型阻塞疏通后1年内妊娠率比较,经统计:A型(χ2=1.47,P=0.832)、C型(χ2=6.80,P=0.0785)无统计学意义;B型(χ2=16.90,P<0.001)、D型(χ2=27.03,P<0.001)存在统计学意义。2组中同型阻塞疏通后1年内发生TP情况比较,经统计:A型(χ2=2.315,P=0.5432)、C型(χ2=2.261,P=0.6019)无统计学意义;B型(χ2=15.672,P<0.001)、D型(χ2=17.44,P<0.001)存在统计学意义。2组中1年后发生再阻塞同型比较,经统计:A型(χ2=1.47,P=0.832)无统计学意义;B型(χ2=25.98,P<0.001)、C型(χ2=29.08,P<0.001)、D型(χ2=32.67,P<0.001)均存在统计学意义。结论如果炎症仅局限于输卵管的间质、峡部的疏通(A型),2组术后结局相当,其他类型的阻塞,特别是B、D类,妇科内镜组疏通后的妊娠率、输卵管妊娠率以及再阻塞机会,均优于放射介入组。

[Objective] To evaluate the different effects between gynecological endoscope and radio-intervention treatment in 268 cases of infertility caused by fallopian tube obstruction in different portion. [Methods] The 268 patients were divide into four types of salpingemphraxis by hysterosalpingogram （HSG） or laparoscopic diagnosis, proximate obstruction （A type）, middle and distal end obstruction （B type）, hydrosalpinx （C type） and fallopian tube surrounded by adhesions or fimbria atresia（D type）. They were divided into two groups by different treatment, 138 cases in endoscope group were treated by gynecological endoscope and 130 cases in intervention group according to radio-intervention treatment. The patients were treated by deoppilation technique in fallopian tube and comprehensiveness anti-inflammatory treatment for three months. Follow-Up for one year, to compare the difference between the same type of two groups in normal pregnancy, fallopian pregnancy（TP） and the tubal reobstruction. [Resuit] Pregnancy rate （PR） between the same type of two groups in one year after treated by deoppilation technique in fallopian tube was compared. Between A type （χ^2=1.47, P =0.832） and C type （χ^2=6.80, P =0.079）, there was no significant difference between two groups; Between B type （χ^2=16.90, P 〈0.001） and D type （χ^2=27.03, P 〈0.001）, there was significant difference. Between A type （χ^2=2.32, P =0.543） and C type （χ^2=2.26, P=0.602） there was no significant difference; Between B type （χ^2=15.67, P 〈0.001） and D type （χ^2=17.44, P 〈0.001）, there was significant difference. The tubal reobstruction： in A type （χ^2=-1.47 P =0.832） there was no significant difference; B type （χ^2=25.98, P 〈0.001）, C type （χ^2=29.08, P 〈0.001）, D type （χ^2=32.67, P 〈0.001）, there was significant difference among those groups. [Conclusion] The outcome of two groups after the operation would be alike if the inflammation was only limited in the interstitial and isthmic portion of the tube （A type）. In other types of obstruction, especially B and D type, the outcome by gynecological endoscope would be better than radio-intervention treatment.