腹腔镜在不明原因不孕症中诊断和治疗的临床研究

Clinical study of laparoscopy in the treatment ofunexplained infertility

目的探讨不明原因不孕症中盆腔腹膜子宫内膜异位症的诊断以及治疗方法。方法选择323例不明原因不孕患者行腹腔镜手术,诊断盆腔腹膜子宫内膜异位症患者手术采用病灶内凝固术及腹腔冲洗方法,术后分2组观察妊娠情况:对照组为术后6个月内妊娠情况,治疗组为术后口服达那唑6个月,停药后6个月内妊娠情况,比较2组妊娠率。结果323例不明原因不孕患者中盆腔腹膜子宫内膜异位为274例占84.8%,对照组妊娠率81.4%,治疗组妊娠率为76.9%,2组比较差异无统计学意义(P>0.05)。结论对不明原因的不孕患者应尽早行腹腔镜检查,对盆腔腹膜子宫内膜异位症采用腹腔镜下病灶内凝固术及腹腔冲洗可有效提高妊娠率,提倡术后半年内妊娠,如半年后不孕者可考虑药物治疗。

Objective To investigate the diagnosis and the treatment of pelvic peritoneum endometriosis in unexplained infertility. Methods 323 patients with unexplained infertility underwent laparescopy, and the plasma coagulation in lesions and the peritoneal washing were performed in patients who were diagnosed pelvic peritoneum endometriosis. We divided them into two groups and observed their pregnancy after operation. The pregnancy rate were observed in control group 6 months after operation, while the treatment group treated with oral administration danazol for 6 months after operation were also observed their pregnancy after drug withdral for 6 months. Results 274 cases of 323 patients with unexplained infertility were diagnosed pelvic peritoneum endometriosis（84. 8% ）. The pregnancy rate in control group was 81.4%, and in treatment group was 76. 9%, which was no significant between them （P 〉 0. 05 ）. Conclusions Patients with unexplained infertility should perform laparoscopy as soon as possible, and using the plasma coagulation in lesions and the peritoneal washing may effectively improve the pregnancy rate in patients with pelvic peritoneum endometriosis. It is advocated pregnancy 6 months after operation, and drug therapy may be considered in infertility patients for 6 months after operation.