宫腔镜联合腹腔镜在女性不孕症诊治中的应用

Application of Hysteroscopy Combined with Laparoscopy in the Diagnosis and Treatment of Infertilitas Female

目的:探讨宫腔镜联合腹腔镜在女性不孕诊断及治疗中的临床应用价值。方法:回顾性分析60例我院收治的采用宫腔镜联合腹腔镜进行诊断和治疗的女性不孕症患者为研究对象,对其临床资料进行分析。结果:宫腔镜联合腹腔镜检查发现,60例不孕症患者中,56.7%的患者患有慢性盆腔炎,16.7%的患者为子宫内膜异位症,11.7%的患者为多囊卵巢综合征;单纯腹腔镜检查的阳性检出率为60.0%,单纯宫腔镜检查的阳性检出率为28.3%,宫腔镜联合腹腔镜检查的阳性检出率高达91.7%,宫腔镜联合腹腔镜镜检阳性发现率明显高于前二者(P<0.05)。治疗前,双侧不通、一侧通畅和双侧输卵管通畅的患者分别为38.3%、48.3%和13.3%,经宫腔镜联合腹腔镜治疗后分别为11.7%、50.0%和38.3%,差异均有统计学意义(P<0.05)。34例原发性不孕患者,术后13例妊娠,妊娠率38.2%;26例继发性不孕患者,术后15例妊娠,妊娠率57.7%;总妊娠率为46.7%,其中宫外孕2例。结论:宫腔镜联合腹腔镜检查可帮助明确女性不孕症患者明确原因及发病部位,并可针对病因进行治疗,提高女性不孕症的病因诊断准确率及治愈率。

Objective： To evaluate the clinical value ofhysteroscopy combined with laparoscopy in the diagnosis and treatment of female infertility. Methods： 60 cases of female infertility patients were diagnosed and treated by laparoscopy combined with hysteroscopy, and their clinical data were retrospectively analyzed. Results： By using laparoscopy combined with hysteroscopy, chronic pelvic diseases was the main reason of infertility. In the pelvic diseases, the common causes included pelvic adhesion（56.7%）, endometriosis（16.7%） and polycysfic ovary syndrome （11.7%）. The diagnostic positive rate oflaparoscopy was 60.0%, hysterosalpingography was 28.3%, whereas, laparoscopy combined with hysteroscopy was 91.7%, which was significantly higher than those in the laparoscopy or hysterosalpingogra- phy.. Before treatment, bilateral obstruction was found in 38.3 % cases, unilateral obstruction was found in 48.3 % cases, 13.3 % cases were dound to be unobstructed; after treatment by laparoscopy and hysterosalpingography, bilateral obstruction was found in 11.7 % cases, unilateral obstruction was found in 50.0 % cases, 38.3 % cases were dound to be unobstructed, which were significant lower or higher than that before treatment （P〈0.05）. All the patients received follow-up by 12 months, the pregnancy rate in secondary infertility patients was57.7%, in primary infertility was 38.2%, and the total pregnancy rate was 46.7%. Out of these 28 patients, 26 patients were intrauterine and 2 were extrauterine. Conclusion： Laparoscopy combined with hysteroscopy was effective in confirming the causes of female infertility and the location of the pelvic disease. Besides, the method was one of preferred choice for female infertility, as the diseases can be treated immediately after the diagnosis and improved diagnose and cure rate for female infertility.