宫腹腔镜联合应用在治疗输卵管性不孕中的临床效果研究

Study on the clinical effect of hysteroscopy combined with laparoscopy in treatment of tubal infertility

目的:探讨宫腔镜和腹腔镜联合治疗输卵管性不孕的效果。方法:选择2011年1月至2013年12月期间185例输卵管性不孕症患者为研究对象,按照治疗方法的不同分为两组。观察组(100例)给予宫腔镜和腹腔镜联合治疗。对照组(85例)给予宫腔镜下输卵管插管通液术治疗。统计受试者接受治疗后手术时间、术后肛门排气时间、术后住院时间、妊娠率(术后6个月、12个月、18个月、24个月)、术后输卵管复通率、不同输卵管病变程度的妊娠率。结果:两组患者在手术时间、术后肛门排气时间、住院天数方面比较,差异无统计学意义(P>0.05)。两组术前输卵管通畅率比较,差异无统计学意义(P>0.05),观察组术后复通率高于对照组(P<0.05)。观察组术后6个月、12个月、18个月妊娠率均高于对照组(P<0.05),但术后24个月两组妊娠率差异无统计学意义(P>0.05)。观察组轻度粘连、中度粘连患者妊娠率高于对照组(χ2=17.660 3,P=0.000 0;χ2=6.485 9,P=0.010 9),两组重度粘连患者妊娠率比较,差异无统计学意义(P>0.05),观察组轻度粘连患者妊娠率高于本组未妊娠率(χ2=29.3913,P=0.000 0),但观察组中度粘连、重度粘连患者妊娠率和未妊娠率比较,差异无统计学意义(P>0.05)。结论:腹腔镜联合宫腔镜治疗输卵管性不孕具有微创、术后恢复快等优点,患者术后可以获得更高的输卵管复通率和妊娠率;腹腔镜联合宫腔镜治疗效果与输卵管粘连程度相关。

Objective： To explore the clinical effect of hysteroscopy combined with laparoscopy in treatment of tubal infertility. Methods ： A total of 185 patients with tubal infertility from January 2011 to December 2013 were selected as research objects and divided in- to two groups： 100 patients in observation group were treated with hysteroscopy combined with laparoscopy, 85 patients in control group were treated with hysteroscopic tubal catheterization and hydrotubation. The operation time, the postoperative anal exhausting time, the postopera- tive hospitalization time, the pregnancy rates at 6, 12, 18 and 24 months after operation, the postoperative tubal recanalization rates and the pregnancy rates of patients with tubal lesions of different degrees were analyzed. Results： There was no statistically significant difference in operation time, the postoperative anal exhausting time, the postoperative hospitalization time and preoperative tubal patency rate between the two groups （ P 〉 0. 05 ） . After operation, the tubal recanalization rate in observation group was statistically significantly higher than that in control group （P 〈0.05 ） . The pregnancy rates at 6, 12 and 18 months after operation in observation group were statistically significantly higher than those in control group （ P 〈 0. 05 ） , but there was no statistically significant difference in the pregnancy rate at 24 months after operation between the two groups （ P 〉 0. 05 ） . The pregnancy rates of patients with mild and moderate adhesion in observation group were statistically significantly higher than those in control group （X^2 = 17. 660 3, P = 0. 000 0; X^2 = 6. 485 9, P = 0. 010 9 ）, there was no statisti- cally significant difference in the pregnancy rate of patients with severe adhesion between observation group and control group （ P 〉 0. 05 ） . Among the patients with mild adhesion in observation group, the pregnancy rate was statistically significantly higher than the unpregnancy rate （X^2 =29. 391 3, P =0. 000 0） , but for the patients with moderate and severe adhesion, there was no statistically significant difference be- tween the pregnancy rate and the unpregnancy rate （ P 〉 0. 05 ） . Conclusion ： Laparoscopy combined with hysteroscopy has the advantages of minimal invasion and quick recovery after operation in treatment of tubal infertility, and the patients can obtain higher tubal rccanalization rate and pregnancy rate; the clinical effect is related to the degree of tube adhesion.