腹腔镜手术治疗输卵管性不孕症86例临床分析

Laparoscopic operation in treatment of tubal infertility： clinical analysis of 86 cases

目的探讨腹腔镜手术对输卵管性不孕症的治疗价值。方法腹腔镜下对碘油子宫输卵管造影确诊为输卵管性病变的86例不孕症患者，腹腔镜进行输卵管伞端成形术、输卵管造口术、输卵管吻合术、粘连松解术及病灶清除等手术。术后随访观察患者的妊娠情况。结果造成输卵管性不孕症的主要病因是输卵管周围粘连40例，占46．51％；其次为输卵管积水18例，占20．93％。手术后通畅效果较好的为输卵管周围粘连、输卵管积水、输卵管积脓。不同病因输卵管疏通率不同，经比较有显著性差异（χ^2=31．48，P〈0．01）。共计77条输卵管经治疗被疏通，总有效率为89．53％；术后随访2年共有48例患者妊娠，其中异位妊娠2例，宫内妊娠46例，宫内妊娠率为53．49％；25例在半年内受孕，占29．07％；14例在1年内受孕，占16．28％。结论腹腔镜手术在输卵管性不孕症治疗方面有较高的临床价值。

Objective To explore the treatment value of laparoscopic operation in treatment of tubal infertility. Methods Eighty-six cases of tubal infertility patients, who were diagnosed with tubal infertility by lipiodol hysterosalpingography, underwent laparoscopic tubal fimbria angioplasty, tubal ostomy, tubal anastomosis, lysis of adhesions and focal cleaning. The pregnant status of them was followed up postoperatively. Results The peritubal adhesion was a major cause of tubal infertility （40 cases）, occupying 46. 51%; followed by hydrosalpinx （18 cases） , accounting for 20.93%. Operation effect was better for peritubal adhesion, hydrosalpinx and pyosalpinx. The dredging rates of different etiologies were different, and there were significant differences （χ2 = 31.48 ,P 〈 0.0O1 ）. A total of 77 fallopian tubes were dredged, and the total effective rate was 89.53%. There were 48 cases with postoperative pregnancy during 2-year follow-up. Among these, there were 2 cases of ectopic pregnancy and 46 cases of intrauterine pregnancy, with intrauterine pregnancy rate of 53.49%. Twenty-five patients were pregnant in six months, accounting for 29.07%. Fourteen cases were pregnant within one year, accounting for 16.28%. Conclusion Laparoscopic operation has higher clinical value in treatment of tubal infertility.