盆腔粘连对输卵管复通术及妊娠结局的影响

Impact of Pelvic Adhesion on the Fallopian Tube Recanalisation and Pregnancy Outcomes

目的：探讨盆腔粘连对输卵管近端阻塞和远端闭锁复通术及妊娠结局的影响。方法：选择1 038例因输卵管性不孕接受宫-腹腔镜联合复通手术的患者,根据手术探查是否有盆腔粘连分为盆腔粘连组738例,对照组300例,分析2组患者输卵管近端阻塞率、远端闭锁复通率和妊娠结局。结果：盆腔粘连组输卵管远端闭锁率较对照组高（42.3%vs.14.5%,P=0.000,OR=4.32,95%CI：3.02-6.17）,2组输卵管近端阻塞率差异无统计学意义（P〉0.05）。但是盆腔粘连组输卵管近端阻塞复通率低于对照组（59.3%vs.75.5%,P=0.005,OR=0.47,95%CI：0.28-0.80）,2组输卵管远端闭锁的复通率相似（84.2%vs.86.0%,P〉0.05）。盆腔粘连组宫内妊娠率低于对照组（22.6%vs.39.6%,P〈0.001,OR=0.444,95%CI：0.282-0.698）,而术后异位妊娠率高于对照组（7.2%vs.2.7%,P=0.02）,尤其是Ⅲ度粘连患者异位妊娠率较对照组高（12.0%vs.2.7%,P=0.01,OR=4.62,95%CI：1.29-16.50）。对于单纯远端输卵管闭锁和合并近端远端输卵管病变的患者来说,复通术后2年仍未妊娠的患者合并盆腔粘连的比例高于成功获得宫内妊娠者（94.4%vs.82.1%,91.8%vs.67.3%,P〈0.05）,但是在单纯输卵管近端阻塞患者中未发现这一现象。结论：盆腔粘连降低了输卵管近端阻塞的复通率,同时降低输卵管远端闭锁患者复通术后的宫内妊娠率,并增加术后异位妊娠的风险。

Objective：To explore the impact of pelvic adhesion on the fallopian tube recanalisation and the pregnancy outcomes of proximal and distal tubal surgery. Methods：The clinical data were collected from 1 038 patients who received hysteroscopic/laparoscopic examination and treatment in our hospital due to infertility.Those patients were divided into two groups according to the degree and scope of pelvic adhesion, the pelvic adhesion group included 738 cases and the control group included 300 cases without pelvic adhesion. The rates of proximal salpingemphraxis and distal fallopian tube recanalisation, and pregnancy outcomes, were analysed.Results：The incidence of distal tubal atresia in the pelvic adhesion group was higher than that in the control group（42.3% vs. 14.5%, P=0.000, OR=4.32, 95%CI：3.02-6.17）. There was no significant difference in the rate of proximal obstruction between the two groups（P〉0.05）. However, the rate of proximal tubal recanalisation in the pelvic adhesion group was lower than that in the control group（59.3% vs. 75.5%, P=0.005, OR=0.47, 95%CI：0.28-0.80）. There was no significant difference in the rate of distal tubal recanalisation between the two groups（84.2% vs. 86.0%, P〉0.05）. The intrauterine pregnancy rate was lower in the pelvic adhesions group than that in the control group（22.6% vs. 39.6%, P〈0.001, OR=0.444, 95%CI： 0.282-0.698）, while the incidence of postoperative ectopic pregnancy was higher in the pelvic adhesions group（7.2% vs. 2.7%, P=0.02）, especially in patients with degree Ⅲ adhesions（12.0% vs. 2.7%, P=0.01, OR=4.62, 95%CI： 1.29-16.50）. The incidence of pelvic adhesions was lower in patients who got intrauterine pregnant after distal tube occlusion only and proximal combined with distal surgery than that in patients who did not get pregnant（94.9% vs. 82.1%, 91.8% vs. 67.3%,P〈0.05）. Conclusions：Pelvic adhesions reduce the rate of proximal tubal recanalisation, and the rate of intrauterine pregnancy in postoperative patients with distal salpingemphraxis. Pelvic adhesions also increase the long-term risk of ectopic pregnancy in those postoperative patients.