输卵管性因素不孕症的腹腔镜分析

A laparoscopical analysis on tubal sterility

目的 应用腹腔镜探讨不同的感染因素与输卵管性因素不孕者的盆腔病变程度的关系。方法 采用腹腔镜对 70例输卵管性不育患者的盆腔情况进行观察 ,同时进行输卵管通畅度的检查及病理检查。结果 输卵管性不孕占不孕患者的 34 .0 % ,其中生殖器结核占 47.1% ,非特异性盆腔炎 (NPI)占 5 2 .9% (P<0 .0 1) ,在输卵管完全梗阻方面 ,生殖器结核组占 80 .3% ,非特异性盆腔炎组占 5 8.1% (P<0 .0 1) ;在输卵管与外周重度粘连方面 ,生殖器结核组占 81.8% ,非特异性盆腔炎组占 36 .5 % (P<0 .0 1)。在输卵管与外周重度粘连且输卵管完全梗阻中 ,TB组为 71.2 % ,非特异性盆腔炎组为 2 1.6 % ,两组差别极显著 (P<0 .0 1)。结论 生殖器结核输卵管病理改变程度较非特异性盆腔炎明显 ;对原因不明的不孕患者应常规进行腹腔镜检查 ,尽早明确诊断 。

Objective Using laparoscopy to make clear the seriousness of pelvic lesions in those barren cases whose sterility is due to tubal factor or due to various infectious factors.Method Seventy cases of tubal sterility received laparoscopical examination on the pelvic cavities;their tubal clearness tests and pathologic findings were also obtained.Results Of all the barren cases the tubal sterilities accounted for 34.0%,of which the genital tuberculosis (TB) cases made up 47.1%,and the nonspecific pelvic inflammation (NPI) cases 52.9% (P<0.01).Of the genital TB cases 80.3% had a complete fallopian tube obstruction,while NPI cases had that in 58.1% of them (P<0.01).Severe peritubal adhesions accounted for 81.8% of the TB cases,those accounted for 36.5% of the NPI cases (P<0.01).Both severe peritubal adhesion and complete tubal obstruction happened in 71.2% of the TB cases,while that happened only in 21.6% of the NPI cases;a very significant difference existed between the two groups (P<0.01).Conclusion Genital TB brings a more noticeable pathologic change to fallopian tubes than NPI does.A routine laparoscopical check must be undergone by those barren cases with unknown cause so as to find out correct diagnosis and rational treatment.