介入性输卵管再通术联合腹腔镜治疗输卵管阻塞性不孕症的临床价值

Infertilitas feminis caused by salpingemphraxis： therapeutic alliances of oviduct recanalization and video-laparoscope

目的探讨介入性输卵管再通术联合腹腔镜治疗输卵管多发阻塞性不孕症的临床价值。方法回顾性分析67例127条输卵管近段阻塞合并同侧伞端粘连不孕患者资料，行选择性输卵管再通术后2～3d利用腹腔镜对粘连伞端行分离及造口术。分析输卵管近三段再通率、完全再通率，随访1年观察妊娠率及相关并发症等。对术后1年未妊娠者行输卵管造影复查。结果67例均成功实施输卵管再通术，近三段再通率为97．6％（124／127）；联合腹腔镜对近三段再通的124条输卵管行伞端微创手术治疗，完全再通率为98．4％（122／124）。术后1年妊娠率为58．2％（39／67），异位妊娠发生率为4．5％（3／67），未妊娠率为37．3％（25／67），其中输卵管再阻塞未妊娠率为25．4％（17／67），输卵管通畅未妊娠率为11．9％（8／67）。结论介入性输卵管再通术联合腹腔镜是治疗输卵管多发阻塞性不孕症的有效方法，可有效提高妊娠率。

Objective To explore the clinical value of therapeutic alliances of oviduct recanalization and video-laparoscope in the treatment of infertilitas feminis caused by multiple salpingemphraxis. Methods Sixty-seven patients with salpingemphraxis in 127 oviducts complicated with adhesions in fimbriated extremities were enrolled into our study. All the patients underwent separation of adherences in fimbriated extremities and neostomy using a video-laparoseope 2 to 3 days after selective oviduct recanalization. The therapeutic effects were retrospectively reviewed focusing on reeanalization rate of proximal three segments, complete recanalization rate, and pregnancy rate and relevant complications during the follow-up period were analyzed. And patients with infertilitas feminis in the follow-up period underwent repeated salpingography to determine whether oviduct was repeatedly obstructed. Results The therapeutic alliance of oviduct recanalization and video-laparoscope were performed successfully in this cohort. Owing to the treatment of oviduct recanalization, recanalization rate of proximal three segments was 97.6% oviducts （124/127）. Due to the alliance of oviduct recanalization and video-laparoscope, complete rate of oviduct were 98.4% （122/124）. One year after operation, the pregnancy rate, ectopie pregnancy rate, and non pregnancy rate were 58. 2% （ 39/67 ）, 4. 5% （ 3/67 ）, and 37.3% （ 25/67 ）, respectively. The patients with non pregnancy were composed by repeated oviduct obstruction in 25.4% （17/67） and non obstruction in 11.9% （8/67）. Conclusion Therapeutic alliances of oviduct recanalizatiou and video-laparoscope could be an effective method for the treatment of infertilitas feminis caused by multiple salpingemphraxis, and he helpful for the enhancement of pregnancy rate.