宫腹腔镜联合诊治输卵管阻塞性不孕的临床分析

Clinical analysis of hysteroscopy combined with laparoscopy in diagnosis and treatment of fallopian tube obstructive infertility

目的探讨宫腹腔镜联合应用在诊治输卵管阻塞性不孕的价值,以期对临床提供借鉴。方法选取2009年1月至2012年1月在广州市天河妇幼保健院诊断为输卵管阻塞性不孕患者125例,随机分为宫腹腔镜联合术组(观察组)63例和腹腔镜术组(对照组)62例,随访12~18个月,比较腹腔镜与术前经子宫输卵管碘油造影(1HSG)诊断符合率,术后两组输卵管通畅程度、再次宫内妊娠等情况,采用Logistic回归分析妊娠结局的影响因素。结果腹腔镜术与HSG诊断符合率为80.00%;观察组术后通畅率和宫内妊娠率均高于对照组(x^2=5.383,4.992,P<0.05),影响宫内妊娠的因素有输卵管近端梗阻、远期再通和远端积水。结论宫腹腔镜联合应用是诊治输卵管阻塞性不孕的有效方法,具有临床推广应用价值。

Objective To explore the value of hysteroscopy combined with laparoscopy in diagnosis and treatment of fallopian tube obstructive infertility , so as to provide reference for clinics .Methods From January 2009 to January 2012 125 patients were diagnosed with fallopian tube obstructive infertility in Maternal and Children ’ s Health Hospital of Tianhe District .They were randomly divided into hysteroscopy combined with laparoscopy group （ observation group , n=63 ） and laparoscopy group （ control group , n=62 ） .They were followed up for 12 to 18 months.The diagnostic accordance rate of laparoscopy and HSG , fallopian tube patency and second intrauterine pregnancy were compared , and Logistic regression analysis was used to analyze the influencing factors of pregnancy outcomes .Results The diagnostic accordance rate of laparoscopy and HSG was 80.00%.The patency rate and intrauterine pregnancy rate of the observation group were significantly higher than the control group （χ2 value was 5.383 and 4.992, respectively, both P〈0.05）.The reproductive outcomes were related to proximal tubal obstruction , recanalization of fallopian tube forward and distal hydrosalpinx . Conclusion Suitable hysteroscopy combined with laparoscopy is an effective method in diagnosis of fallopian tube obstructive infertility , and it is worthy of promotion in clinics .