宫腔镜下输卵管插管介入治疗输卵管性不孕675例临床分析

Clinical Analysis of 675 Patients with Tubal Infertility Treated by Fallopian Tube Intubation Interventional Therapy with Hysteroscope

目的评价宫腔镜下输卵管插管介入治疗输卵管性不孕的临床疗效。方法对675例输卵管性不孕患者在宫腔镜下行选择性输卵管造影和输卵管再通术,统计输卵管再通率、宫内妊娠率、异位妊娠率和管腔再闭塞率,并对不同梗阻部位的再通率进行对比分析。结果本组867条梗阻的输卵管中,773条(占89.1%)获再通,其中275条(占31.7%)输卵管仅行SSG即获再通,间质部、峡部、壶腹部和伞部的再通率分别为94%,90.2%,69.2%,65%,间质部和峡部的再通率明显高于壶腹部和伞部(P<0.01);475条通而不畅的对输卵管中,331条(占69.6%)获完全通畅,其中178条(占37.4%)仅行SSG即获完全通畅。随访至术后48个月,双侧梗阻组的宫内妊娠率、异位妊娠率和管腔再闭塞率分别为39.5%、4.2%和13.9%;一侧梗阻一侧不畅组分别为34.2%、5.6%和13.1%;双侧不畅组分别为36.4%、4.7%和12.9%,三组间比较差异无显著性(P>0.05)。结论宫腔镜下SSG和FTR,插管成功率高,治疗效果可靠,可作为输卵管性不孕的首选治疗方法,值得临床推广应用。

Objective To appraise the clinical curative effect of tubal infertility treated by fall-opian tube intubation interventional therapy with hysteroscope. Methods To carry out SSG and FTR by fallopian tube intubation with hysteroscope to 675 patients with tubal infertility in order to calculate fallopian tubes recanalization rates, intrauterine gestation rates, eccyesis rates and tube repeated blocked rates,and to run contrast analysis to the recanalization rates of fallopian tube＇s different parts. Results There were altogether 867 obstructive fallopian tubes in this study,773 （89.1%） could get recanalization,in which 275 （31.7%） fallopian tubes could get recanalization only with SSG,the recanalizafion rates of interstitial portion,isthmic portion, ampulla and fimbria were 94% ,90.2% ,69.2%, 65%. The reeanalization rates of interstitial portion and isthmic portion were higher obviously than ampulla and fimbria （P〈0.05）; There were altogether 475 fallopian tubes which not be smooth, 331（69.6%） could get recanalization, in which 178（37.4%） fallopian tubes could get reeanalization only run SSG. Follow-up visited the patients 48 months after the operation,we discovered that the group of two-side obstruction＇s intrauterine gestation rates, eccyesis rates and tube repeated blocked rates were 39.5%,4.2% and 13.9%; The group of one side obstruction and another side not smooth were 34.2%, 5.6% and 13.1%; The group of two sides not smooth were 36.4%, 4.7% and 12.9%, there was no significant difference amongthree groups（P〉0.05）. Conclusion CanTing out SSG and FTR by fallopian tube intubation with hysteroscope can make an higher achievement ratio and curative effect dependable,and can be taken as the first selective treatment method for tubal infertility.