腹腔镜输卵管造口术治疗输卵管积液所致不孕症的疗效分析

Analysis of the effect of laparoscbpic salpingostomy in the treatment of infertile caused by hydrosalpinx

目的分析腹腔镜输卵管造口术对输卵管积液所致不孕症的治疗效果，探讨提高受孕率的合理治疗方案。方法对130例输卵管积液的不孕症患者行输卵管造口术，不成功部分患者切除输卵管；比较造口成功与不成功患者及输卵管切除与未切除患者间术后自然受孕和人工受孕率的差异。结果130例患者造口成功85例，成功率65．4％，造口成功85例中有40例在造口后做体外受精-胚胎移植（IVF—ET）行人工助孕治疗，造口成功患者术后妊娠29例，妊娠率为34．1％；单侧输卵管积液患者术后自然妊娠率（17．9％）与双侧输卵管积液患者（16．7％）差异无统计学意义（X2=0．06，P〉0．05），但人工妊娠率（70．O％）高于双侧积液者（35．0％）（x2=4．912，P〈0．05）。造口不成功患者45例均行IVF治疗2次以上，术后妊娠率为8．9％；45例不成功患者中14例行输卵管切除，31例未切除，IVF治疗后受孕率输卵管切除患者（21．4％）高于未切除患者（3．2％）（x。=3．946，P〈0．05）。造口成功患者人工受孕率（52．5％）高于造口不成功行输卵管切除术的患者（21．4％）（x2=4．055，P〈0．05）。结论输卵管造口术可提高自然及人工受孕率，若造口不成功切除输卵管利于IVF的成功。

Objective To analyze the effect of laparoscopic salpingostomy in the treatment of infertile caused by hydrosalpinx,and explore the reasonable treatment method for improving pregancy rate. Methods 130 infertile women with hydrosalpinx were treated with salpingostomy firstly, some unsuccessful cases were treated with salpingec- tomy. The pregnancy rate between successfully salpingostomied patients and unsuccessfully salpingostomied patients was also compared. Results 85 cases were salpingostomied successfully, the successful rate was 65.4%, among these patients 40 received IVF-ET, there was no difference in the natural pregnancy rate between singly hydrosalpinx （ 17. 9% ） and double hydrosalpinx（ 16.7% ） （ X2 = 0.06, P 〉 0.05 ）, but the artificial pregnancy rate in single hydro- salpinx（70.0% ） was higher than double hydrosalpinx（ 35.0% ） （X2 = 4. 912, P 〈 0.05 ）. Among 45 unsuccessfully salpingostomied patients, 14 cases underwent salpingectomy, all patients received more than two times of IVF-ET treatment,the pregnancy rate in salpingectomied patients （ 21.4% ） was higher than unsalpingectomied （ 3.2% ） （ X2 = 3. 946, P 〈0. 05 ）. The artificial pregnancy rate of successfully salpingostomied patients （52.2%） was higher than un- successful patients（21.4% ） （X2 =4.055,P〈0.05）. Conclusion Salpingostomy can raise the pregnancy rate（nat- ural or artificial） ,it is beneficial to do salpingectomy for unsuccessfully salpingostomied patients who want to receive IVF-ET.