妇科内窥镜治疗输卵管阻塞性不孕临床价值的研究

Research on the Clinical Value of the Treatment for Infertility Caused by Fallopian Tube Obstruction Using Gynecological Endoscope

目的:通过分析268例输卵管阻塞性不孕经内窥镜疏通治疗的结局,评估妇科内窥镜在治疗输卵管阻塞性不孕的临床价值。方法:268例输卵管阻塞性不孕患者根据术前HSG影像或腹腔镜术中诊断分为A组(近端阻塞型)、B组(中远端阻塞型)、C组(输卵管积水型)、D组(输卵管和周围组织粘连、伞端闭锁型),经妇科内窥镜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4组术后的正常妊娠、输卵管妊娠、再阻塞情况。结果:1年内A组妊娠率最高,输卵管妊娠、再阻塞率最低,B、D组次之,C组妊娠率最低,输卵管妊娠、再阻塞率最高。结论:炎症仅局限于输卵管的间质、峡部的阻塞通过妇科内窥镜疏通术后,其妊娠率最高,输卵管妊娠发生率、再阻塞率最低。

Objective：To analyze the clinical outcomes of 268 cases with infertility caused by fallopian tube obstruction using gynecologic endoscopic,and evaluate the clinical value of gynecologic endoscopic.Methods：The 268 patients with infertility caused by fallopian tubal obstruction were divided into four groups,group A（proximate obstruction）,group B（middle and distal end obstruction）,group C（hydrosalpinx）,and group D（fallopian tube surrounded by adhesions or fimbria atresia）,according to the hysterosalpingogram（HSG） images or laparoscopic diagnosis.All patients of the 4 groups were treated by deoppilation operation of fallopian tube through gynecological endoscope,comprehensive anti-inflammatory therapy for 3 months post-operation,and 1 year follow-up.The status of normal pregnancy,fallopian pregnancy（TP）,and tubal re-obstruction post-operation were compared among the 4 groups.Results：In 1 year after deoppilation operation,the pregnancy rate of group A was the highest,while the rates of TP and tubal re-obstruction were the lowest.The pregnancy rates of group B and D were relative low,and group C had the lowest pregnancy rate,with the highest rates of TP and tubal re-obstruction.Conclusion：The type that obstruction caused by the inflammation limited in the interstitium and isthmic portion of fallopian tube,can obtain a relative good clinical outcome with the highest pregnancy rate and the lowest rates of TP and tubal re-obstruction,after the deoppilation operation through gynecological endoscope.