腹腔镜手术配合术后排卵监测治疗输卵管性不孕46例分析

The laparoscopic operation plus of ovulation monitor for tubal infertility.

目的 探讨对盆腔炎所致的输卵管性不孕症的治疗方法和经验。方法 经子宫输卵管造影(HSG)检查证实双侧输卵管均存在病变的不孕症患者 ,于月经干净后3～7d内行腹腔镜手术。术中证实所有病例均存在双侧输卵管及周围病变 :粘连、积水或远端闭锁。镜下施行粘连分离 ,输卵管矫形 ,伞端造口术 ,并镜下直视输卵管通液 ,显示矫治术后输卵管均通畅。术后第1～6个月的月经中期前行阴道B超监测卵泡发育直至排卵 ,适时指导患者夫妻同房时间。结果 46例输卵管粘连或远端闭锁患者 ,经腹腔镜手术矫治 ,输卵管通畅成功率100%,妊娠24例 ,妊娠率52%,其中已分娩18例。结论 腹腔镜微创手术矫治输卵管粘连 ,远端闭锁是有效的 ,如在短期内辅以阴道B超监测排卵管指导受孕时间 ,能提高妊娠率。

Objective To summarize our experience of treatment on tubal infertility caused by pelvic inflammation. Methods 46 cases of tubal infertility proved by hysterosalpingogrphy were treated with laparoscopic operation. All the cases with chronic inflammatory lesion showed hydrosalpinx or distal occlusion caused by bilateral tubes-adhesion. Salpingolysis, salpingoplasty or salpingostomy was performed on those patients. All the fallopian tube were proved unobstructed after operation by hydrotubation seen directly under laparoscopy. Follicular development was monitored by vaginal type B utrasound untill ovulation to guide the coitus behavior on proper time. Result All 46 cases showed fluent tubes after operation, with 100% success rate. 24 cases were pregnant, the pregnant rate is 52%. 18 cases have deliveried. Conclusion Laparoscopic operation is an effective way to treat salpingo adhesion and distal occlusion. Monitor follicular by vaginal B-us in a short-term after operation, the pregnant rate can be incrsased.