介入再通术与宫腔镜、腹腔镜联合治疗输卵管近端阻塞的对比研究

Comparative study on interventional recanalization and laparoscopy combined with hysteroscopy for proximal tubal obstruction

目的比较介入再通术与宫腔腹、腹腔镜联合导丝疏通治疗输卵管近端阻塞的临床价值。方法子宫输卵管造影显示为双侧输卵管近段阻塞的不孕症患者,根据患者的要求随机分为2组。A组104例X线下行介入输卵管再通治疗术;B组48例行宫腔腹、腹腔镜联合导丝疏通治疗输卵管治疗术。结果 A组输卵管的再通率88.2%(179/203),B组为90.4%(85/94);13个月后输卵管的再阻塞率A组为16.8%(30/179),B组为14.1%(12/85);随访1年,两组宫内妊娠率A组26.7%(20/75),B组29.8%(14/47);输卵管妊娠率A组2.7%(2/75),B组2.1%(1/47)。结论选择性输卵管介入再通术能复通大部分输卵管近端阻塞,可作为有效治疗方法之一。

Objective To compare the clinical effects of interventional recanalization and laparoscopy combined with hysteroscopy for treatment of proximal tubal obstruction. Methods Interventional recanalization （Group A）and laparoscopy combined with hysteroscopy （Group B ）for proximal tubal obstruction were performed for 104 and 44 infertile cases with fallopian tubes obstruction diagnosed by hystero-salpingography （HSG） and studied respectively. Results 88.2% （ 179/203 ）of fallopian tubes were recanalizated in group A and and 90.4% （85/94）in group B. The fallopian tubes reocclusion rate was 16.8% （30/179） and 14.1% （ 12/85 ）in group A and group B respectively 13 months later. In one years follow-up, uterine pregnancy occurred in 26. 7% （20/75）of patients in group A and 29.8% （ 14/47）of patients in group B, and tubal pregnancy occurred in 2.7% （2/75）of patients in group A and 2.1% （ 1/47）of patients in group B. Conclusion Selective salpingography can recanalized the obstructive fallopian tube in majority of proximal occlusions and should be the first choice of therapy.