宫腹腔镜联合手术诊治女性不孕症262例疗效评价

Evaluation of the curative effect of hysteroscopy combined with laparoscopy for diagnosis and treatment of 262 cases with female infertility

目的:探讨宫腹腔镜联合手术在诊治女性不孕症中的临床价值。方法:回顾性分析2004年1月～2010年1月因不孕症接受宫腹腔镜联合手术诊治的患者262例,镜下评估不孕症的病因,观察术后患者输卵管通畅情况和妊娠率。结果:262例不孕症患者中,盆腔病变107例,宫腔病变90例,同时存在盆腔和宫腔病变65例。慢性盆腔炎与盆腔粘连是引起女性不孕症的首位病因,主要引起继发不孕。子宫内膜异位症、多囊卵巢综合征也是引起女性不孕症的重要原因,主要引起原发不孕。术前输卵管通畅率为74.13%,术后输卵管通畅率为91.11%。术后随访1～24月,223例获随访,随访率为85.11%。术后妊娠135例,妊娠率为51.53%,异位妊娠14例(5.34%),流产10例(3.82%)。结论:宫腹腔镜联合手术在诊治女性不孕症方面能够优势互补,在诊断的同时给予治疗,漏检率低、创伤小、并发症少,对女性不孕症的诊治有重要的临床价值。

Objective： To explore the clinical value of hysteroseopy combined with laparoscopy for diagnosis and treatment of cases with female infertility. Methods ： A total of 262 patients with infertility who underwent hysteroseopy combined with laparoscopy for diagnosis and treatment in the hospital from January 2004 to January 2010 were analyzed retrospectively, the causes of infertility were assessed under hysteroscope combined with laparoscope, the patency of Fallopian tubes and pregnancy rate of the patients after operation were observed. Results： Among 262 patients with infertility, 107 patients were found with pelvic cavity lesions, 90 patients were found with uter- ine cavity lesions, and 65 patients were found with pelvic cavity lesions combined with uterine cavity lesions. Chronic pelvic inflammatory disease and pelvic adhesion mainly induced secondary infertility, which were the first causes of female infertility. Endometriosis and polycys- tie ovarian syndrome were important causes inducing female infertility, which mainly induced primary infertility. The patency rates of Fallopi- an tubes before and after treatment were 74. 13% and 91.11% , respectively. A total of 223 patients were followed up for 1 -24 months after treatment, the rate of follow -up was 85. 11%. After treatment, 135 patients got pregnancy, the pregnancy rate was 51.53% ; 14 patients got ectopic pregnancy, the pregnancy rate was 5.34% , and 10 patients underwent abortion, the rate of abortion was 3.82%. Conclusion： Hysteroseopy combined with laparoseopy for diagnosis and treatment of female infertility can complement with each other, diagnosis and treat- ment are performed simultaneously, which has the advantages of low false negative rate, less trauma, and less complications, and the method has important clinical value for diagnosis and treatment of female infertility.