内镜治疗输卵管阻塞不孕的临床疗效及其影响因素

Clinical effect of endoscopic treatment for infertility induced by Fallopian tube obstruction and the influencing factors

目的:探讨输卵管阻塞致不孕患者内镜治疗的临床疗效及影响术后治疗效果的相关因素。方法:将120例因输卵管阻塞致不孕患者根据治疗方式分为研究组(68例)和对照组(52例),研究组采用宫腹腔镜联合手术进行治疗,对照组采用腹腔镜微创手术进行治疗,两组患者疏通治疗后采用综合性抗感染治疗3个月,抗感染治疗结束后观察两组患者的输卵管畅通及阻塞情况,同时分析影响120例患者术后妊娠的影响因素。结果:研究组和对照组患者术后并进行综合抗感染治疗3个月后,两组患者的输卵管通畅、不畅或一侧畅通、阻塞率比较差异均不具有统计学意义(P>0.05);研究组和对照组的宫内孕、异位妊娠、未孕、总有效率比较差异均不具有统计学意义(P>0.05);术后发生未孕率最高的是输卵管积水型患者,异位妊娠率最高的是中远段阻塞型患者,术后宫内孕成功率最高的是中远段阻塞型患者。各种输卵管阻塞类型患者的术后效果比较具有统计学差异(χ2=8.601,P=0.047)。结论:宫腹腔镜联合或宫腹腔镜联合治疗对输卵管阻塞致不孕治疗的效果相当,影响术后治疗效果的主要原因是输卵管积水。

Objective： To explore the clinical effect of endoscopic treatment for infertility induced by Fallopian tube obstruction and the influencing factors of postoperative treatment. Methods： A total of 120 infertile cases induced by Fallopian tube obstruction were divided into study group（ 68 cases） and control group（ 52 cases） according to treatment methods; the cases in study group were treated by hysteroscopy,laparoscopy combined with operation,while the cases in control group were treated by hysteroscopic minimally invasive surgery,the the cases in the two groups were treated by comprehensive anti- inflammatory therapy for 3 months. After comprehensive anti- inflammatory therapy,tubal conditions in the two groups were observed,the influencing factors of pregnancy after operation of the 120 cases were analyzed. Results： After comprehensive anti- inflammatory therapy,there was no statistically significant difference in tubal conditions（ tubal patency,tubal obstruction,unilateral patency） between the two groups（ P〈0. 05）; there was no statistically significant difference in intrauterine pregnancy rate,ectopic pregnancy rate,unpregnancy rate and the total effective rate between the two groups（ P〈0. 05）; unpregnancy rate was the highest in cases with hydrosalpinx,ectopic pregnancy rate was the highest in cases with middle and distal Fallopian tube obstruction,intrauterine pregnancy rate was the highest in cases with middle and distal Fallopian tube obstruction. There was statistically significant difference in postoperative effect among the cases with various types of tubal obstruction（ χ2= 8. 601,P = 0. 047）. Conclusion： The curative effects of hysteroscopy,laparoscopy combined with operation and hysteroscopic minimally invasive surgery are similar,the main influencing factor of postoperative effect is hydrosalpinx.