不同输卵管粘连分级对宫腹腔镜联合手术治疗效果的影响

Clinical effects of oviductive adhesion on hysteroscopy combined with laparoscopy

目的 探讨不同输卵管粘连分级对宫腹腔镜联合手术治疗输卵管性不孕的影响.方法 选择经子宫输卵管碘油造影诊断为输卵管性不孕的314例患者,行宫腹腔镜联合手术,根据术中所见将输卵管粘连程度分为4级,并视术中所见进行相应的治疗.对不同分级的临床妊娠率、异位妊娠率进行对比观察.结果 术前子宫输卵管碘油造影与术中所见输卵管粘连分级（Ⅰ～Ⅳ级）的诊断符合率分别为75.0%（21/28）、47.8%（54/13）、95.8%（115/120）、73.6%（39/53）.输卵管粘连Ⅰ～Ⅲ级的临床妊娠率分别为71.4%（20/28）、42.5%（48/113）、15.0%（18/120）,异位妊娠率分别为0、2.1%（1/48）、16.7%（3/18）,各分级间差异均有统计学意义（P＜0.05或P＜0.01）.结论 输卵管粘连分级越低,宫膜腔镜联合手术治疗输卵管性不孕的疗效越好.术前、术中进行输卵管粘连分级可为选择个体化治疗方案提供客观依据,因而具有临床推广意义.

Objective To explore the clinical effects on oviduct adhesion in treatment of hysteroscopy combined with laparoscopy. Methods Three hundred and fourteen cases of patients with oviductive infertility were diagnosed by hysterosalpingography （HSG） and were treated by hysteroscopy and laparoscopy, according to HSG of preoperation and the degree of fallopian adhesion in operation, fallopian tubal adhesion were divided into Ⅰ , Ⅱ ,Ⅲ, Ⅳgrades. Results The consistent results of HSG and hysteroscopy combined with laparoscopy were 75%, 47.8% , 95.8%, 73.6%. The clinical pregnancy rates of different grade were 71.4%, 42.5%, 15%. The rates of ectopic pregnancy were 0, 2%, 16%, respectively, the difference was statistically significant （P 〈 0. 05 or P 〈0. 01 ）. Conclusions The lower grade of tubal disease shows, the better operation result will be achieved. The result of the operation depends on the degree of oviductal adhesion.