输卵管堵塞诊治效果与子宫内膜异位症的相关性研究

The correlation between the management of tubal obstruction and endometriosis

目的探讨在输卵管堵塞患者中,子宫输卵管四维超声造影(4D-HyCoSy)的诊断效果及宫腹腔镜联合手术的疗效与子宫内膜异位症(EM)的相关性。方法回顾性分析65例行4D-HyCoSy及宫腹腔镜联合手术的不孕症患者的临床资料,其中27例合并EM(不孕合并EM组),38例无EM(对照组),比较两组患者4D-HyCoSy的假阳性率、输卵管再通率、术后自然妊娠率及并发症发生率的差异。结果不孕合并EM组4D-HyCoSy诊断输卵管堵塞的假阳性率为21.62%(8/37),与对照组(6.67%,3/45)比较,差异有统计学意义(P=0.048);不孕合并EM组术后再通率为71.43%(10/14),与对照组(37.93%,11/29)比较,差异有统计学意义(P=0.039);不孕合并EM组患者术后6个月自然妊娠率为16.67%(3/18),与对照组(4.76%,1/21)比较,差异无统计学意义(P=0.318);不孕合并EM组患者术后下腹痛、阴道出血发生率分别为62.96%(17/27)和77.78%(21/27),对照组分别为73.68%(28/38)和65.79%(25/38),两组比较,差异均无统计学意义(P=0.356、0.295)。结论合并EM的不孕症患者经4D-HyCoSy诊断为输卵管堵塞,应积极进行宫腹腔镜联合手术。

Objective To investigate the influence of endometriosis（EM）on the diagnosis and treatment of tubal obstruction.Methods Retrospective analysis was carried out on 65 infertile women（27with EM and 38 without EM）,who took both 4D-HyCoSy and hysteroscopy combined with laparoscopy.Results False-positive rate of tubal obstruction is higher in EM group（21.62%）than that in non-EM group（6.67%）（P=0.048）.The recanalization rate of EM group is 71.43%,significantly higher than that of non-EM group（37.93%）（P=0.039）.But the pregnancy rate showed no difference between two groups（P=0.318）.Besides,the prevalence of post-operative abdominal pain and vaginal bleeding in EM group are 62.96% and 77.78%,while those of non-EM group are 73.68% and 65.79%,revealing no difference between two groups（P=0.356,0.295）.Conclusion For infertile woman with EM,if diagnosed as tubal obstruction by 4D-HyCoSy,should be advised to take hysteroscopy combined with laparoscopy.