轻中度输卵管积液腹腔镜下输卵管造口术后妊娠结局分析

Analysis of pregnancy outcome of patients with mild and moderate hydrosalpinx after laparoscopy salpingostomy

目的探讨轻中度输卵管积液患者经腹腔镜行输卵管造口术后最佳妊娠时间,并分析妊娠结局。方法选取成都市妇女儿童中心医院2009年1月至2014年1月至少一侧输卵管轻中度积液不孕患者198例,分析不同程度积液患者经腹腔镜下输卵管造口术后妊娠结局、复发情况和妊娠时间。结果 198例患者中总妊娠率39.90%、活产率27.78%、异位妊娠率9.60%、流产率2.53%、复发率9.60%。单侧输卵管轻度积液患者术后总妊娠率(53.85%)、活产率(46.15%)高于中度积液患者(38.89%、25.00%),复发率(0)低于中度积液患者(5.56%),差异均有统计学意义(P<0.05)。双侧输卵管轻度积液患者术后总妊娠率(37.93%)、活产率(25.86%)高于中度积液患者(24.14%、10.34%),复发率(8.62%)低于中度积液患者(24.13%),差异均有统计学意义(P<0.05)。总妊娠率、活产率、复发率单侧输卵管积液患者术后分别为47.73%、37.5%、2.23%,双侧输卵管积液患者分别为33.64%、20.00%、15.45%,差异有统计学意义(P<0.05);不同类型、不同程度输卵管积液患者术后异位妊娠率、流产率比较,差异均无统计学意义(P>0.05)。79例妊娠患者术后1年内的妊娠率(36.87%)与术后1~2年的妊娠率(3.03%)比较,差异有统计学意义(P<0.05)。结论输卵管积液不孕患者造口术后轻度积液患者、单侧积液患者术后妊娠率、活产率高于中度积液、双侧积液患者,复发率低于中度积液、双侧积液患者。造口术后1年内是患者获得妊娠的最佳时机。

Objective To discuss the appropriate pregnancy time of patients with mild and moderate hydrosalpinx after laparoscopic salpingostomy, and to analyze the pregnancy outcome. Methods A total of 198 infertile patients with mild to moderate hydrosalpinx from January 2009 to January 2014 in Chengdu Women and Children s Central Hospital were selected to analyze the pregnancy outcome, recurrence situation and pregnancy time after laparoscopic salpingostomy in patients with different degrees of effusion. Results The total pregnancy rate was 39. 90 %, the live birth rate was 27. 78 %, the ectopic pregnancy rate was 9. 60 %, the abortion rate was 2. 53 %, and the recurrence rate was 9. 60 %. The postoperative total pregnancy rate (53. 85 %) and live birth rate (46. 15 %) in patients with mild unilateral hydrosalpinx were higher than those in moderate unilateral hydrosalpinx (38. 89 %, 25. 00 %),and the recurrence rate (0) was lower than that of patients with moderate unilateral hydrosalpinx (5. 56 %). The total pregnancy rate ( 37. 93 %) and live birth rate ( 25. 86 %) in patients with bilateral mild hydrosalpinx were higher than those in patients with bilateral moderate hydrosalpinx (24. 14 %, 10. 34 %), and the recurrence rate ( 8. 62 %) was lower than bilateral moderate hydrosalpinx patients (24. 13 %)(P <0. 05 ). The total pregnancy rate, live birth rate, and recurrence rate were 47. 73 %, 37. 5 %, and 2. 23 % respectively in patients with unilateral hydrosalpinx. The patients with bilateral hydrosalpinx were 33. 64 %, 20. 00 %, and 15. 45 % respectively. The differences were statistically significant(P < 0. 05). There was no significant difference in postoperative ectopic pregnancy rate and miscarriage rate among patients of different types and degrees of hydrosalpinx ( P > 0. 05 ). The pregnancy rate (36. 87 %) within one year of pregnancy in 79 pregnant patients was significantly different from the pregnancy rate (3. 03 %) in postoperative one to two years ( P < 0. 05 ). Conclusion Patients with mild and unilateral hydrosalpinx after laparoscopic salpingostomy have a higher pregnancy rate and live birth rate, lower recurrence rate than patients with moderate and bilateral hydrosalpinx. Within one year after laparoscopic salpingostomy is the best time for the patient to obtain pregnancy.