宫腔镜、腹腔镜联合下行输卵管间质部插管再通术治疗输卵管近端阻塞

Fallopian tube recanalization under laparoscopy and hysteroscopy in treatment of proximal tubal occlusion

目的探讨宫腔镜、腹腔镜联合下行输卵管间质部插管再通术治疗输卵管近端阻塞的疗效。方法选择2008年10月一2009年3月同济大学附属第一妇婴保健院收治的原发或继发不孕患者33例,术前均行子宫输卵管碘油造影检查证实一侧或双侧输卵管近端阻塞。行宫腔镜、腹腔镜联合手术,并对近端阻塞输卵管行间质部插管再通,随后再行通液术,比较手术效果。结果 33例患者55根近端阻塞的输卵管,结果经输卵管口插管通液后完全通畅1根,部分通畅33根,不通21根。完全通畅率、通而不畅率分别为1.8%、60.0%,完全不通率为38.2%。随后行间质部插管通液,33例55根输卵管均行间质部插管通液,结果完全通畅28根,部分通畅23根,不通4根。完全通畅率、通而不畅率分别为50.9%、41.8%,完全不通率为7.3%。间质部插管通液术后输卵管完全通畅率显著高于经输卵管口插管(P<0.05),而完全不通率显著低于经输卵管口插管(P<0.05)。结论宫腔镜、腹腔镜联合输卵管间质部插管再通术对输卵管近端阻塞的患者有较好的疗效,其输卵管的通畅度较常规通液术有明显改善。

Objective To explore the efficacy of fallopian tube recanalization under laparoscopy and hysteroscopy in treatment of proximal tubal occlusion.Methods Thirty-three infertile patients,who had uniateral or bilateral proximal tubal occlusion as confirmed by hysterosalpingography from Oct.2008 to March 2009,were included in the present study.All the patients were operated on under laparoscopy and hysteroscopy.During the operation,recanalization through guide wire were done among patients with proximal tubal occlusion,and then the tubal dye tests were done again.The outcomes were compared before and after the procedure.Results The 33 patients had a total of 55 proximal tubal occlusions.After fluid infusion of fallopian tubes,1 tube was completely patent,33 tubes were partly patent,and 21 tubes were occluded,with the patent rate being 1.8%,partly complete rate being 60.0%,and the occluding rate being 38.2%.All the cases received recanalization through a guide wire,and the results showed that 28 tubes were completely patent,23 were partly patent,and 4 were occluded,with the complete patent rate being 50.9%,partly patent rate being 41.8%,and occluding rate being 7.3%.The completely patent rate was higher after recanalization through guide wire than that after regular dye tests;meanwhile,the occluding rate was significantly lower after recanalization through guide wire（P〈0.05）.Conclusion Recanalization through guide wire under laparoscopy and hysteroscopy has a better effect on proximal tubal occlusion.Recanalization through guide wire can achieve higher patent rate than regular dye tests.Thus this procedure may serve as a routine treatment for surgical treatment of infertility.The method is economical,safe,and effective,and it is worth popularizing.（Shanghai Med J,2010,33：750-753）