宫腹腔镜下输卵管植入术治疗近端输卵管不孕53例

Clinical effect of tubal implantation with hysteroscopy combining laparoscopy for the treatment of 53 cases of proximal tubal infertility

目的探讨宫腹腔镜联合下行输卵管宫角植入术治疗近端输卵管性不孕的临床价值。方法选择2011年3月至2013年3月间我科收治的门诊子宫输卵管造影提示输卵管间质部或峡部阻塞的53例不孕患者,术中均经宫腹腔镜检查证实为输卵管间质部或峡部阻塞,且经宫腔镜下Cook导丝输卵管介入疏通失败者为患者实施宫腹腔镜下宫角输卵管植入术。结果 53例患者中共实施宫角植入术65条,术后一个月行宫腔镜检查并输卵管通畅度检查,植入后的输卵管通畅率达100%,随访1年内32例正常受孕,1例输卵管妊娠,20例未孕,妊娠率达60.37%,目前足月经阴道分娩5例,剖宫产1例。结论宫腹腔镜下输卵管宫角植入术治疗近端输卵管性不孕是一种微创、有效、安全的方法,有临床推广价值。

Objective To explore the clinical value of tubal implantation with hysteroscopy combining lapa-roscopy for the treatment of proximal tubal infertility. Methods Fifty-three infertile patients in our department diag-nosed as interstitial tubal occlusion or isthmus by hysterosalpingography and proved by hysteroscopy and laparoscopy from March 2011 to March 2013 were involved in the study. The patients failed in treatment of hysteroscopic tubal cook guidewire were further treated with tubal implantation in the uterine horn under hysteroscopy and laparoscopy. Results A total of 65 tubal implantation were performed in 53 patients. Hysterosalpingography and hysteroscopy were used to check the patency rate after one month, and the tubal patency rate was 100%. Within the 1 year fol-low-up, 32 patients had normal pregnancy, one had tubal pregnancy, and 20 had no pregnancy. The total pregnancy rate was 60.37%. Up to now, 5 patients had mature vaginal delivery, and 1 had cesarean section. Conclusion Tubal implantation in the uterine horn with hysteroscopy combining laparoscopy is a minimally invasive, effective and safe way for the treatment of proximal tubal infertility, which should be applied widely.