181例输卵管梗阻的宫、腹腔镜治疗

Laparoscopic and Hysteroscopic Surgery for Oviduct Obstruction: a Report of 181 Cases

目的探讨宫、腹腔镜联合介入治疗对输卵管梗阻复通的效果及妊娠结局。方法2005年2月～2011年6月，对腹腔镜监视下通液证实的输卵管梗阻181例共339条输卯管，行腹腔镜下盆腔粘连分解、输卵管造口成形以及宫、腹腔镜联合输卵管插管复通手术。结果输卵管伞端粘连、输卵管积水主要行腹腔镜下粘连分解及伞端造口、成形术，复通的成功率100．0％（102／102），56条外观正常的输卵管中46条通过加压通液及经宫腔镜输卵管插管通液复通，复通率82．1％（46／56），外观异常的输卵管梗阻通过腹腔镜辅助下经宫腔镜输卵管插管复通及经腹腔镜逆行插管复通，复通率峡部梗阻为60．5％（46／76），壶腹部梗阻为43．8％（46／105）。随访3～48个月，平均13．5月。术后自然妊娠率59．7％（108／181）。结论宫、腹腔镜联合导管介入治疗及腹腔镜下粘连分解、输卵管造口成形术是治疗输卵管梗阻的有效方法，术后可获得较为满意的妊娠结局。

Objective To explore the recanalization efficacy and pregnancy outcome of laparoscopic and hysteroscopic surgery for the treatment of oviduct obstruction. Methods From February 2005 to June 2011, 181 cases of 339 obstructive tubes were confirmed after hydrotubation under laparoscope, and underwent adhesiolysis of perisalpingo-ovaritis, salpingostomy and plasty, and intubate recanalization of the oviduct guided by hysteroscope and laparoscope. Results Totally 102 tubes with fimbria adhesion and hydrops were recanalized mainly by adhesiolysis, salpingostomy and plasty, and the recanalization ratio was 100% （102/102） ; 56 tubes with normal shape were recanalized by pressurizing hydrotubation and intubating hydrotubation under hysteroscope, and the recanalization ratio was 82. 1% （46/56）; 181 tubes with abnormal shape were recanalized mainly by intubated under hysteroscope assisted by laparoscope, and retrograde catheterization by.laparoscope, and the recanalization ratio was 60.5% （46/76） in isthmus obstruction and 43.8% （46/105） in ampulla obstruction respectively. All patients were followed up for 3 to 48 months （mean, 13.5 months）. Natural pregnancy rate was 59.7% （108/181）. Conclusions Laparoscopic and hysteroscopic surgery is an effective therapy for the treatment of oviduct obstruction by adhesiolysis and salpingostomy. Pregnancy outcomes are satisfactory after the surgery.