经宫腔镜插管介入治疗输卵管阻塞性不孕的临床价值

A clinical study of hysteroscopy-guided interventional therapy to treat fallopian tube obstructive infertility

目的 观察经宫腔镜插管介入治疗输卵管阻塞性不孕的临床价值.方法 选择不孕症患者92例,将自愿接受宫腔镜引导下输卵管造影及介入治疗的56例患者作为观察组,同期采用导丝法介入治疗的36例作为对照组.观察组经宫腔镜检查及镜下插入微导管,数字减影血管造影（DSA）下行选择性输卵管造影,对阻塞的输卵管采用微导管超液态碘化油加压法联合微导丝进行输卵管再通术;对照组在DSA引导下经宫颈管放入5.0F导管后引入同轴3.0F微导管及微导丝直接疏通.观察2组检查及治疗情况.结果 观察组中发现宫腔内异常病理变化21例（37.5％）,输卵管阻塞35例53条,复通成功率为100％.术后3个月行输卵管碘油造影（HSG）检查,观察组与对照组成功率分别为91.4％和63.9％,总有效率为94.3％和80.6％,2组疏通成功率及总有效率比较,差异均有统计学意义（P＜0.05）.随访1年,观察组与对照组妊娠率分别为42.9％和33.3％.结论 经宫腔镜插管在DSA下介入治疗输卵管阻塞性不孕,可避免对输卵管内膜造成的直接损伤,疗效较好.

Objective To assess the application of hysteroscopy - guided interventional therapy to fallopian tube obstructive infertility. Methods Ninety - two patients with infertility were enrolled in the study, in which fifty - six re- ceived hysteroscopy - guided hysterosalpinography and interventional therapy, while thirty - six were included into a con- trol group and treated using guide wires. After insertion of microtubes guided by hysteroscopy, the patients in the treat- ment group received hysterosalpingography （HSG） under digital subtraction arteriography （DSA）, in which obstructive fallopian tubes were unblocked by lipiodol ultra - fluid and guide wires. In control group, a catheter and guide wire sys- tem was adopted to remove tubal obstructions under DSA. All examination results and therapeutic effects were recorded. Results The treatment group reported 21 cases of abnormal pathological changes in the uterus cavity （37.5%） and 53 obstructive fallopian tubes in 35 patients, with an unblocked rate of 100%. According to HSG examination, the success- ful rate was 91.4% for the treatment group and 63.9% for the control, with a total effective rate of 94.3% and 80.6% respectively three months after operation （P 〈 0.05）. The pregnancy rate was 42.9% for the treatment group and 33.3% for the control after an average follow - up of one year. Conclusions Hysteroscopy - guided catheterization can be ap- plied for interventional treatment of fallopian tube obstructive infertility under DSA, which minimizes direct damage towards the endomembrane of the fallopian tube and produce more satisfactory therapeutic effects.