腹腔镜单用与宫腹腔镜联合应用在治疗不孕症中的对比分析

Comparison of hysteroscopy combined with laparoscopy or laparoscopy alone in treatment of infertility

目的探讨宫腹腔镜联合应用在诊治女性不孕症中的价值和治疗后卵巢储备功能变化情况,并与腹腔镜单用诊治进行比较。方法收集该科2010年1月～2011年12月治疗的238例不孕症患者的临床资料,分为宫腹腔镜联合治疗组(观察组)和腹腔镜单用治疗组(对照组),观察对比两组病因构成,并对患者治疗后妊娠情况及卵巢储备功能进行随访。结果两组患者都以输卵管病变和盆腔病变为多见,观察组宫腔粘连、子宫肌瘤、纵隔子宫、子宫内膜息肉的检查阳性率明显高于对照组,两者比较差异有显著性(P<0.05)。治疗后通过随访,观察组妊娠88例,妊娠率达61.54%,对照组妊娠46例,妊娠率为48.42%,两组比较差异有显著性(P<0.05)。各组患者血清FSH、LH和E2水平在治疗后1个月较治疗前和治疗后其他时间结果差异有显著性(P<0.05),两组间血清FSH、LH和E2水平差异无显著性(P>0.05);两组间治疗前后卵巢截面积、PSV和EDV比较差异无显著性(P>0.05),各组治疗后1个月的卵巢截面积、EDV和PSV参数较治疗前和治疗后其他时间结果差异有显著性(P<0.05)。结论联合应用宫腹腔镜是诊治女性不孕症的有效方法,能够直观、准确、全面地对盆腔及宫腔进行检查,根据病因采取有针对性的治疗,能够提高妊娠率,具有临床推广应用价值。

[Objective] To investigate the value of combined use of hysteroscopy and laparoscopy in diagnosis and treatment of female infertility and evaluate the ovarian reserve function change after the laparoscopic operation. [Methods] 238 female infertile patients who underwent laparoscopic operation in our hospital during Jan.2010 and Dec. 2011 were randomly divided into observation group and control group. The pregnancy rate and ovarian reserve function changes were followed up. [Results] Uterine tube and pelvic diseases were the factors that led to infertility. The positive rate of uterine diseases in observation group was higher than that in control group （P 0.05）. By follow up after treatment,88 patients were pregnant, the rate was 61.54% in observation group, 46 patients were pregnant,the rate was 48.42% in control group, there was significant difference between the two groups （P 0.05）. There was significant difference in the levels of FSH, LH and E2 at the first month after surgery in the two groups （P 0.05）. There was no significant difference in the levels of FSH, LH and E2 between the two groups （P 0.05）. The PSV,EDV and ovarian size values all decreased significantly at the first month after surgery in the two groups （P 0.05）. There was no significant difference in the PSV, EDV and ovarian size values between the two groups （P 0.05）. [Conclusion] Laparoscopy combined with hysteroscopy is a valuable method in the diagnosis and treatment of female infertility. Under anesthesia,we can examine the pelvic and uterine directly and accurately, determine the causes of infertility, then give treatment. This kind of procedure is valuable and should be encouraged to be performed.