超声监视下举宫器联合经阴道注水腹腔镜检查在不孕症中的应用价值

Application value of transvaginal hydrolaparoscopy combined with uterine manipulator under ultrasound in infertility

目的探讨超声监视下举宫器联合经阴道注水腹腔镜检查在不孕症中的应用价值。方法对符合举宫器联合经阴道注水腹腔镜检查的不孕症患者68例,在超声介入监视下进行检查,观察盆腔情况。结果 68例患者中一次性穿刺进入盆腔,腹腔镜沿穿刺针路径顺利进入子宫直肠陷窝66例,穿刺成功率占97.05%(66/68)。超声显示液池中盆腔粘连带26例,占33.23%(26/68),腹腔镜检查盆腔粘连带31例,占45.58%(31/68),符合率83.87%(26/31)。因盆腔粘连严重或输卵管伞端闭锁改行标准腹腔镜检查22例,占32.4%(22/68);无直肠损伤、术后穿刺部位出血、盆腔感染等并发症发生。结论超声监视下经阴道穿刺成功率高,可避免穿刺针具意外损伤盆腔脏器,超声显示盆腔粘连与腹腔镜检查有相似结果,对提高不孕症的诊疗发挥了重要作用。

Objective To explore the application value of tmnsvaginal hydrelaparoscopy combined with uterine manipulator under ultrasound in infertility. Methods Sixty-eight patients with infertility which were suitable for uterine manipulator combined with transvaginal hydrolaparoscopy were examined under ultrasound, and the pelvic cavity situation was observed. Results The puncture needling instrument was seen in pelvic cavity in 68 patients in first time of puncturing. In 66 patients laparoscope was put in uterus rectum lacuna along the puncture path successfully. The puncture success ratio was 97.05% （66/88）. Under ultrasound, in 26 patients the pelvic adhesion in liquid pool was shown, accounting for 33.23% （26/68）. Also,under laparoscopy, pelvic adhesion was shown in 31 patients, accounting for 45.58% （31/68）. Compared these two examinations, coincidence rate was 83.87% （26/ 31 ）. Twenty-two patients had to be changed to standard laparoscopy for severe pelvic adhesion or fimbrla tube uterine atresia, accounting for 32. 4% （22/68）. There was no complication, such as rectum damage, bleeding after operation in puncturing place and pelvic cavity infection. Conclusion The success ratio of puncturing through vagina under ultrasound is high. It can avoid accidental pelvic organs injuries. The result of pelvic adhesion shown by ultrasound resembles that of laparoscopy. It is helpful for diagnosis and treatment of infertility.