经腹腔镜诊治女性不孕症468例临床分析

Analysis of clinical effect of laparoscopy in diagnosis 468 female infertility patients

目的 探讨腹腔镜检查对女性不孕症的临床诊治价值.方法 回顾性分析468例行腹腔镜检查及手术的女性不孕症患者的临床资料,分析比较原发性不孕与继发性不孕的病因构成及治疗效果,并对168例患者进行随访.结果 在468例不孕症患者中,发现盆腔异常419例（89.53%）,盆腔正常49例（10.47%）;在盆腔异常患者中,输卵管病变276例（65.87%）,子宫内膜异位症62例（14.80%）,卵巢肿瘤25例（5.97%）,多囊卵巢18例（4.30%）,子宫肌瘤16例（3.82%）,生殖道畸形14例（3.34%）、盆腔结核8例（1.91%）.原发性不孕208例,继发性不孕260例.在继发性不孕患者病因中,输卵管病变构成比为69.23%（180/260）,高于原发性不孕组的46.15%（96/208）（x2=14.05,P＜0.05）;在原发性不孕患者病因中,子宫内膜异位症构成比为20.19%（42/208）,高于继发性不孕的7.69%（20/260）（x2=11.78、P＜0.05）;而卵巢肿瘤、多囊卵巢、生殖道畸形、子宫肌瘤、盆腔结核等在原发性不孕和继发性不孕患者病因中构成比差异均无统计学意义（均P＞0.05）;原发性不孕患者中盆腔正常的构成比15.38%（32/208）,高于继发性不孕的6.54%（17/260）（x2=11.16,P＜0.05）.对168例患者进行随访,术后妊娠76例,妊娠时间最短于术后2个月,最长于术后30个月,妊娠时问中位数为8个月;术后6个月内妊娠36例（47.37%）,术后1年内妊娠64例（84.21%）.结论 腹腔镜检查可明确不孕症的诊断,同时提高术后妊娠率.

Objective To explore clinical effects of laparoscopy applied in the female patients with infertility. Methods 468 cases of female infertility patients were diagnosed and treated by laparoscopy and 168 cases received follow-up survey. Results Among those infertility patients, the patients of normal pelvic cavity and the abnormal one were 49（10.47% ） and 419（ 89.53% ）. Among those patients of abnormal pelvic cavity .fallopian tube disease in 276 cases（65.87% ） was at the first place. The constituent ratio of endometriosis,ovary tumor,polycystic ovary,uterine myoma,female genital tract malformation and pelvic tuberculosis was 14. 80% ,5. 97% ,4. 30% ,3. 82% , 3. 34% and 1.91% .respectively. The patients of primary infertility and the secondary ones were 208 and 260 cases. In secondary infertility patients 69.23% （180/260） of patients were caused due to fallopian tube diseases,and the constituent ratio was higher than that in primary infertility 46.15% （96/208） （x2 = 14.05 ,P 〈0.05）,while in primary infertility,the constituent ratio of endometriosis and normal pelvic cavity were 20.19% ,15.38% ,which were higher than that in secondary infertility respectively（x2 = 11. 78,11. 16, all P 〈 0.05）. The pregnancy rate of 168 cases followed-up was 45.24% （76/168）.47.37% ,84.21% pregnancy occurred within 6,12 months with laparoscopy. The shortest and longest time of pregnancy was 2 and 30 months, respectively. The median was 8months. Conclusion Laparoscopy playd an important role in diagnosis of infertility and improvement of pregnancy rate.