腹腔镜手术治疗输卵管扭曲性不孕的临床分析

Laparoscopic treatment of infertility caused by tubal distortion

目的探讨腹腔镜手术治疗输卵管扭曲性不孕的临床价值以及输卵管扭曲程度与术后妊娠率的关系。方法选择因输卵管性不孕行腹腔镜输卵管整形术的患者268例，其中77例为单纯性输卵管扭曲引起的不孕，统计其临床资料和术后6～24个月的随访资料，分析输卵管扭曲程度对妊娠结局的影响。结果输卵管性不孕患者术后总妊娠率为48．9％，宫内妊娠率为44．4％，宫外妊娠率为4．5％。单纯性输卵管扭曲引起的不孕术后妊娠率为41．56％。输卵管扭曲最小成角〈45°22例，术后妊娠5例；成角45°～90°49例，妊娠24例；成角90°-145°6例，妊娠3例。第1组与第Ⅱ组患者术后妊娠率比较差异有统计学意义，第Ⅱ组与第Ⅲ组比较差异无统计学意义。结论通过腹腔镜输卵管整形术解除输卵管扭曲恢复其正常走形是治疗输卵管扭曲性不孕，特别是最小成角〉45°的不孕患者的有效方法。

Objective To investigate the clinical value of laparoscopic treatment of infertility caused by tubal distortion, and the relationship between degree of tubal distortion and postoperative pregnancy rate. Methods Two hundred and sixty-eight cases of tubal infertility underwent laparoscopictreatment, of which 77 cases were caused by simple distorted tubal, the clinical data and 6- 24 months follow-up datas were collected, the effect of tubal distortion on pregnancy out-come was analyzed. Results The total pregnancy rates of the 268 cases were 48.9%, with 44.4% intrauterine pregnancy rate and 4. 5 % ectopic pregnancy rate. In the simple distorted tubal infertility cases, the total pregnancy rate was 41.56%. The minimum angle of tubal distortion 〈45° in 22 cases, and 5 cases got pregnancy after operation; The minimum angle between 45° to 90° in 49 cases, 24 cases of them got pregnancy; The angle between 90° to 145° in 6 cases, 3 cases got pregnancy. The pregnancy rates between group I and group Ⅱ were significantly different, the pregnancy rates between group II and group m have no significant difference. Conclusions Tubal plastic surgery by laparoscope to resume the normal outshape of oviducts is an effective way to treat infertility caused by tubal distortion, especially in the cases when the minimum angle of tubal distortion is larger than 45 ° .