宫腔镜输卵管插管通液术在输卵管性不孕诊治中的应用

Application of Hysteroscopic Tubal Catheterization Hydrotubation in Diagnosis and Treatment of Tubal Infertility

目的探讨宫腔镜下输卵管插管通液术对输卵管通畅度诊断的价值以及对输卵管通而不畅治疗的作用。方法 2009年1～12月120例不孕者(233条输卵管)经子宫输卵管造影术(hysterosalpingography,HSG)诊断为输卵管通而不畅214条,近端阻塞或未显影19条,宫腔镜输卵管插管通液来进一步诊断和治疗。结果 HSG诊断214条输卵管通而不畅,宫腔镜下输卵管插管通液诊断142条通而不畅,63条通畅,9条阻塞;HSG诊断19条输卵管近端阻塞或未显影,宫腔镜下输卵管插管通液诊断10条不通,5条通畅,4条通而不畅。146条(76例)输卵管通而不畅经通液治疗1～3次后,通畅110条(57例),通而不畅36条(19例),插管治疗治愈率75.3%(110/146),病例治愈率75.0%(57/76)。对治疗后通畅的57例术后随访1年,术后1年内受孕率57.9%(33/57),分娩率54.4%(31/57);治疗后输卵管通而不畅的19例建议行宫、腹腔镜联合检查。结论宫腔镜下输卵管插管通液术对输卵管性不孕的诊断和通而不畅的治疗是安全、经济而有效的。

Objective To investigate the diagnostic value of patency, and the treatment efficacy in the incomplete patency oviduct. hysteroscopic tubal catheterization hydrotubation for tubal Methods From January to December in 2009, among the 120 infertile patients （233 oviducts） undergoing hysterosalpingography （HSG）, 214 oviducts were diagnosed as incomplete patency oviduct and 19 oviducts were diagnosed as proximal obstruction or undeveloped. They were further diagnosed and treated by the hysteroscopic tubal cannulation hydrotubation. Results Among the 214 oviducts which were diagnosed as incomplete patency, 142 were diagnosed as incomplete patency by hysteroscopic tubal cannulation hydrotubation, 63 were diagnosed as unobstructed and 9 were diagnosed as obstructed. Among the 19 oviducts diagnosed as proximal obstruction or undeveloped by HSG, 10 were diagnosed as obstructed by hysteroscopic tubal cannulation hydrotubation, 5 were diagnosed as unobstructed and 4 were diagnosed as incomplete potency. 110 （57 cases）of the 146（76 cases） tubals which were diagnosed as incomplete patency were cured after being treated for 1 to 3 times,and only 36（ 19 cases） remained their incomplete patency with the cure rate of incomplete patency oviduct by hysteroscopic tubal catheterization hydrotubation being 75.3% （110/146）. The cure rate of the cases was 75.0% （57/76）. The one-year follow-up of the 57 cases revealed a pregnancy rate of 57.9% （33/57）and a parturition rate of 54.4% （31/57）. For the 19 cases of incomplete potency, we suggested the combination of hysteroscopic and laparoscopic examination. Conclusion The diagnosis and treatment for incomplete patency by hysteroscopic tubal catheterization hydrotubation oviduct is safe, cost-efficient and effective.