3种方式治疗输卵管性不孕的临床效果及影响因素分析

The prospective study of three methods in treatment of tubal factor infertility

目的:探讨不同治疗方法对输卵管性不孕的疗效影响。方法:2006年1月～2008年12月,在3家医疗机构选择输卵管性不孕患者310例,分别接受输卵管通液、宫腔镜输卵管插管疏通、宫腹腔镜联合输卵管疏通手术3种治疗方式,随访1年,记录其妊娠情况。统计分析采用χ2检验和多项logistic模型。结果:共283例得到1年后随访。输卵管通液治疗方式对任何部位阻塞的输卵管疏通效果差,妊娠率较低;近端阻塞患者采用宫腔镜输卵管插管疏通[OR=3.370,95%CI(1.456,7.798)]与宫腹腔镜联合输卵管疏通[OR=3.095,95%CI(1.112,8.614)]疗法宫内妊娠率相当;而远端阻塞患者采用宫腹腔镜联合输卵管疏通[OR=5.962,95%CI(1.497,23.749)]易宫内妊娠。沙眼衣原体阳性、解脲支原体阳性、阻塞程度是影响输卵管性不孕治疗效果的因素。结论:输卵管通液治疗输卵管性不孕效果较差,宫腔镜输卵管插管疏通操作相对简单安全且妊娠率高,宫腹腔镜联合输卵管疏通方式治疗合并有盆腔粘连不孕症的效果更好,且不增加发生异位妊娠的风险。

Objective：To study the different treatments and factors related to tubal factor infertility （TFI）. Methods：A total of 310 women with TFI,who underwent the treatment of hydrotubation,fallopian tubal recanalization by hysteroscopy,and fallopian tubal recanalization by hysteroscopy combined with laparoscopy between Jan,2006 and Dec,2008,were recruited from three hospitals. All the women were followed up for 1 year and the pregnancy rate was evaluated. The chi-square test and multinomial logistic model were used for data analysis. Results：A total of 283 women were included. Hydrotubation had a lower intrauterine gestation rate among the women with proximal and distal occlusion,compared with another two therapies. For the women with proximal obstruction,fallopian tubal recanalization by hysteroscopy [OR=3.370,95%CI（1.456,7.798）] and tubal recanalization by hysteroscopy combined with laparoscopy [OR=3.095,95%CI（1.112,8.614）] had the similar odds ratio of intrauterine gestation. For the women with distal occlusion,tubal recanalization by hysteroscopy combined with laparoscopy had a higher odds ratio than hydrotubation [OR=5.962,95%CI（1.497,23.749）]. Chlamydia trachomatis,Ureaplasma urealyticum and the patency of fallopian tubes were major factors of treatment outcomes. Conclusion：Fallopian tubal recanalization with hysteroscopy and hysteroscopy combined with laparoscopy had better effects for the treatment of TFI and no higher risk of ectopic pregnancy compared with hydrotubation.