2003例不孕症患者宫腔镜检查结果分析

Analysis of 2003 Cases of Diagnostic Hysteroscopy of Infertility

目的:探讨宫腔镜检查在不孕症诊治中的应用价值。方法:回顾性分析实施宫腔镜检查的不孕症患者的病例资料。结果:12 003例患者中,原发不孕762例(38.0%),继发不孕1 241例(62.0%)。2宫腔镜检查显示有宫腔内病变者757例(37.8%),其中原发不孕274例,继发不孕483例,原发不孕和继发不孕组宫腔病变的发生率无统计学差异(P>0.05)。3宫腔内病变分别为:子宫内膜息肉(EP)、子宫内膜增殖症、宫腔粘连(IUA)、子宫内膜结核、子宫畸形、子宫内膜炎、黏膜下肌瘤、子宫内膜癌和宫腔异物9类,原发不孕症中EP、内膜结核、子宫内膜增殖症的发病率均高于继发不孕症组(P<0.05)。继发不孕症中宫腔粘连的发生率明显高于原发不孕症组(P<0.01)。42 003例患者中有体外受精-胚胎移植(IVF-ET)失败病史的182例,其中宫腔内有病变93例(51.1%),显著高于无IVF-ET失败病史者的宫腔内病变率(37.8%)(P<0.01)。结论:不孕症患者的宫腔内病变发生率接近40%,EP是原发不孕症患者最常见的宫腔内病变类型;IUA是继发不孕症患者最常见的宫腔内病变类型。对不孕症患者尤其是有过IVF-ET失败病史的患者,进行宫腔镜检查是非常必要的。

Objective： To discuss the application value of hysteroscopy in the diagnosis and treatment of infertility. Methods： Retrospective analysis of 2 003 infertility cases who were checked by hysteroscopy were performed. The incidence of uterine lesions between primary infertility and secondary infertility was compared.Results： 1） There were 762 cases of primary infertility and 1 241 cases of secondary infertility in all 2 003 cases.2） In all subjects, 757（37.8%） had lesions of which 274 cases（36.0%） in the primary infertility group and 483cases（38.9%） in the secondary infertility group. The difference between these two groups was not significant（P〉0.05）. 3） There were 9 types of pathogeny in 2 003 uterine cavity lesions, which were endometrial polyp（EP）,endometrial hyperplasia, intrauterine adhesion, endometrial tuberculosis, uterine malformation, uterine intimitis,submucous myoma, endometrial cancer and uterine cavity foreign matter. And the proportion of the first four types in the primary infertility group and the secondary infertility group were significantly different（P〈0.05）.4） Among the 2 003 cases, there were 182 cases who had a failure history of IVF-ET. The incidence of uterine cavity lesions in cases with a failure history of IVF-ET was 51.1%（93/182）, which was higher than that of cases without a failure history of IVF-ET（37.8%）. Conclusion： Hysteroscopy plays an important role in the diagnosis and treatments of infertility. EP is the most common type of uterine cavity lesion for primary infertility whereas intrauterine adhesion is the most present in the secondary infertility. Routine hysteroscopy can influence the prognosis resulting from the IVF-ET, especially for the ones who had a history of failure.