531例不孕与不育宫腔镜诊断的宫腔病因分析

Etiological Diagnosis by Hysteroscopy in 531 Patients with Infertility Complicated with Intrauterine Disorders

目的探讨引起女性不孕与不育的宫腔病因。方法1993年3月～2008年3月,对不孕与不育患者做宫腔镜检查,对资料完整的2077例中诊断有宫腔疾病的531例作回顾性总结与分析。其中原发不孕症(原发组)172例(32·4%),继发不孕症(继发组)315例(59·3%),不育(不育组)44例(8·3%)。结果宫腔主要病因:宫腔粘连231例(43·5%),子宫畸形152例(28·6%),子宫内膜息肉88例(16·6%)。3组比较:原发组以子宫内膜息肉为主(38·4%,66/172),明显高于继发组(6·0%,19/315)和不育组(6·8%,3/44)(χ2=80·7630,P=0·000;χ2=16·0463,P=0·000);继发组以宫腔粘连为主(60·6%,191/315),明显高于不育组(25·0%,11/44)和原发组(16·9%,29/172)(χ2=19·9232,P=0·000;χ2=86·0747,P=0·000);不育组以子宫畸形为主(65·9%,29/44),明显高于继发组(25·1%,79/315)和原发组(25·6%,44/172)(χ2=30·5994,P=0·000;χ2=25·4673,P=0·000)。结论不孕与不育的主要宫腔病因:原发不孕是子宫内膜息肉;继发不孕是宫腔粘连;不育是子宫畸形。

Objective To explore the intrauterine disorders that leads to infertility and sterility in women. Methods From March 1993 to March 2008, a total of 2077 patients with infertility received hysteroscopic examination at Nanjing Drum Tower Hospital. Among the patients, 531 were diagnosed with intrauterine abnormalities including primary infertility in 172 （32.4%） cases, secondary infertility in 315 cases （59.3%）, and sterility in 44 （8.3%）. The clinical data of these patients were analyzed retrospectively. Results The most common cause of infertility and sterility in the patients was intrauterine adhesion （231 cases, 43.5% ） , followed by uterine deformities （152, 28.6% ） and endometrial polyps （88, 16. 6% ）. In the primary infertility group, the most common reason was endometrial polyps, which was detected in 38.4% of the cases （66/172）. The rate was significantly higher than that in the secondary infertility group （6.0% , 19/315 ） and sterility group （6.8% , 3/44） （X^2 = 80. 7630, P = 0.000; X^2 = 16. 0463, P = 0. 000）. While in the secondary infertility group, intrauterine adhesion was detected in most of the patients （60. 6% , 191/315 ） , that was significantly more than that in the sterility and primary groups （25.0% , 11/44, X^2 = 19. 9232, P =0. 000 and 16. 9% , 29/172, X^2 =86.0747, P = 0.000, respectively）. For the patients with sterility, the disease was caused by uterine deformities mostly （65.9% , 29/44） , which is significantly different from the other two groups （ secondary group ： 25.1% , 79/315, X^2 = 30. 5994, P = 0. 000; primary group： 25.6%, 44/172, X^2 = 25. 4673, P = 0. 000）. Conclusion The major causes of primary infertility, secondary infertility, and sterility are endometrial polyp, intrauterine adhesion, and uterine deformities respectively.