宫腔镜联合腹腔镜治疗输卵管性不孕的效果

Efficacy analysis of hysteroscopy combined with laparoscopy in treatment of tubal infertility

目的探讨宫腔镜联合腹腔镜治疗输卵管性不孕的效果及输卵管盆腔病变程度对不孕症患者预后的影响。方法对2010年7月~2012年7月浙江省人民医院妇科收治的92例输卵管不孕患者临床资料进行回顾性分析。根据治疗方法将患者分为两组,观察组47例,对照组45例。观察组患者采用宫腔镜联合腹腔镜治疗,对照组采用宫腔镜下进行插管通液术治疗。观察两组患者输卵管再通情况及再阻塞的情况,对比两组患者术后并发下腹持续性疼痛例数及妊娠率。分析输卵管病变程度与妊娠的关系。结果观察组输卵管阻塞再通率（89.41%）明显高于对照组（73.26%）,差异有统计学意义（P〈0.05）,而两组患者术后2个月再阻塞率差异无统计学意义（P〉0.05）。两组患者术后均出现持续性下腹疼痛,观察组1例（2.13%）明显少于对照组3例（6.67%）,差异有统计学意义（P〈0.05）,但两组患者均未见子宫穿孔及大出血等严重并发症。观察组患者术后2年妊娠率（53.19%）明显高于对照组（24.44%）,差异有统计学意义（P〈0.05）。两组患者均出现2例输卵管妊娠,两组比较差异无统计学意义（P〉0.05）。患者输卵管病变程度越重,术后妊娠率越低（P〈0.05）;两组中轻度粘连患者的妊娠率比较,差异有统计学意义（P〈0.05）。结论宫腔镜联合腹腔镜治疗输卵管性不孕可明显提高输卵管阻塞的复通率及患者术后妊娠率,且并发症少,值得临床推广和应用。

Objective To analyze the clinical effect of hysteroscopy combined with laparoscopy in treatment of tubal infertility and effect of degree of tubal pelvic lesions on the prognosis of infertility patients. Methods The clinical data of 92 cases of tubal infertility patients were retrospectively analyzed, who were hospitalized from July 2010 to July 2012 in Department of Gynecology, Zhejiang Province People＇s Hospital. According to the method of treatment, the patients were divided into the observation group （47 cases） and the control group （45 cases）. The observation group was treated by hysteroscopy combined with laparoscopy, and the control group was treated by hysteroscopic catheterization hydrotu- bation. Fallopian tube reeanalization and restenosis rates after 2 months treatment of the two groups were observed. Postoperative abdominal pain cases and pregnancy rate after 2 years treatment in two groups were compared. The rele- vance of tubal lesion degree with pregnancy was analyzed. Results The fallopian tube recanalization rate of observation group was 89.41%, which significantly higher than 73.26% in control group, the difference was statistically significant （P 〈 0.05）. While the difference in restenosis rates was not statistically significant between the two groups after 2- month treatment （P 〉 0.05）. There were patients with abdominal pain both in the two groups. The observation group of 1 cases with abdominal pain （2.13%） was significantly less than that of the control group of 3 cases （6.67%）, the difference was statistically significant （P 〈 0.05）. There was no case of uterine perforation, hemorrhage and other serious complications in the two groups. After 2 years treatment, the pregnancy rate of 53.19% in observation group was higher than 24.44% in the control group, with statistical significance （P 〈 0.05）. There were 2 cases of tubal pregnancy in the two groups respectively, there was no significant difference （P 〉 0.05）. The postoperative pregnancy rate decreased with the increasing tubal disease severity （P 〈 0.05）. The pregnancy rate of patients with mild-to-moderate adhesion in the two groups was compared, the difference was statistically significant （P 〈 0.05）. Conclusion Hysteroseopy and laparoscopy therapy can effectively improve the tubal occlusion reeanalization rate and pregnancy rate, has less complication, worthy of promotion and application.