宫腔镜、腹腔镜联合诊治不孕症的临床观察

Hysteroscopy Combined with Laparoscopy for Diagnosis and Treatment of Infertility

目的探讨宫、腹腔镜联合手术对女性不孕症诊治的应用价值。方法对136例女性不孕症患者行宫、腹腔镜手术治疗的临床资料进行回顾性分析。其中原发性不孕66例,继发性不孕70例。根据患者的病变情况选择输卵管粘连分离术、输卵管伞端成形术、输卵管造口术、输卵管近端阻塞、宫腔镜下电切术后、子宫内膜异位灶电凝术、肌瘤剔除术及卵巢电凝打孔术等。结果 136例女性不孕症患者中,明确病因诊断者113例(83.1%)。腹腔镜检查异常者108例(79.4%),宫腔镜检查异常者62例(45.5%),宫、腹腔镜检查均正常23例(16.9%)。术后2年妊娠率为46.3%(63/136)。继发性不孕组的慢性盆腔炎发生率高于原发性不孕组、子宫内膜异位症发生率低于原发性不孕组(均P<0.01)。2组其他因素(卵巢良性囊肿、多囊卵巢综合征、子宫纵膈)比较差异无统计学意义(P>0.05)。结论宫腔镜与腹腔镜联合手术能集二者之长,同时进行宫腔、盆腔疾病的诊断和治疗,具有创伤小、恢复快、手术成功率高的特点。

Objective To investigate the value of combined hysteroscopic and laparoscopic surgery in the treatment of female infertility.Methods Clinical data of 136 infertile female patients(66 cases of pri-mary infertility and 70 cases of secondary infertility)who underwent combined hysteroscopic and laparo-scopic surgery were analyzed retrospectively.According to the lesions,patients were treated with salpin-golysis,fallopian tube plasty,salpingostomy,proximal tubal obstruction,hysteroscopic electrotomy,endo-metriosis lesion electrocoagulation,myomectomy,and ovarian electrocoagulation drilling,respectively.Re-sults Among the 136 patients,the pathogenesis was confirmed in 113(83.1%).In addition,laparoscopic abnormalities were found in 108 patients(79.4%),and hysteroscopic abnormalities in 62 patients(45. 5%).Both hysteroscopic and laparoscopic results were normal in 23 patients(16.9%).2 years after the pregnancy rate was 46.3%(63/136).Compared with primary infertility group,the incidence of chronic pelvic inflammatory disease increased but the incidence of endometriosis decreased in secondary infertility group(P<0.01).There were no significant differences in the incidences of benign ovarian cysts,polycys-tic ovarian syndrome and uterus mediastinum between the two groups(P>0.05).Conclusion Combined hysteroscopic and laparoscopic surgery is an important procedure for the diagnosis and treatment of uter-ine and pelvic diseases and provides the advantages of small trauma,rapid recovery and high surgery suc-cess rate.