122例输卵管性不孕症的临床情况及宫腹腔镜下输卵管插管介入治疗的应用分析

Clinical analysis of 122 cases of tubal infertility and the application of laparoscopic tubal interventional therapy

目的探讨122例输卵管性不孕症的临床情况及宫腹腔镜下输卵管插管介入治疗的应用效果。方法选取2015年1月至2016年12月重庆市人口和计划生育科学技术研究院诊治的122例输卵管性不孕症患者作为研究对象。回顾性分析122例患者的临床资料,分析采用宫腹腔镜下输卵管插管介入治疗输卵管性不孕症临床效果。结果 122例患者,共有174条输卵管阻塞,再通154条,总再通率为88.51%,其中108条为宫腹腔镜下输卵管插管再通,占比为70.13%,伞端、壶腹部、峡部、间质部的再通率分别为64.71%、66.67%、89.83%、94.38%,峡部、间质部的再通率明显高于伞端、壶腹部,差异具有统计学意义(P<0.05);通而不畅输卵管共100条,治疗后完全畅通68条完全畅通,畅通率为68%,其中45条为宫腹腔镜下输卵管插管再通,占比66.18%;1年后对治疗成功的患者进行随访发现,双侧阻塞组异位妊娠(4%)、宫内妊娠(40%)以及管腔再闭塞(14%)与一侧阻塞一侧不畅组异位妊娠(10%)、宫内妊娠(30%)以及管腔再闭塞(10%)以及双侧通而不畅组异位妊娠(4.55%)、宫内妊娠(36.36%)以及管腔再闭塞(13.64%)相比差异较小,差异无统计学意义(P>0.05)。结论宫腹腔镜联合输卵管插管介入治疗输卵管性不孕症,插管成功率较高,输卵管再通率较高,术后并发症较少,安全高效,值得临床推广应用。

Objective To investigate the clinical condition of 122 cases of tubal infertility and the effect of interventional treatment of tubal intubation under hysteroscopy and laparoscopy.Methods 122 cases of tubal infertility were selected from January 2015 to December 2016 in our hospital.The clinical data of the 122 cases was analyzed retrospectively.The clinical effect of interventional treatment of tubal infertility by hysteroscopy and laparoscopy was analyzed.Results There were 174 fallopian tubes obstruction and 154 fallopian tubes recanalization in the 122 patients,the total recanalization rate of 88.51%.108 of them were fallopian tube recanalization under hysteroscopy and laparoscopy,accounting for 70.13%.The recanalization rates of umbrella end,ampulla,isthmus and interstitium were 64.71%,66.67%,89.83%and 94.38%,respectively.The recanalization rates of isthmus and interstitium were obviously higher than those of umbrella end and ampulla(P<0.05).100 unobstructed fallopian tubes were completely unobstructed after treatment,68 of them were completely unobstructed,the unobstructed rate of 68%,of which 45 were recanalized by fallopian tube intubation under hysteroscopy and laparoscopy,accounting for 66.18%.Follow-up of successful patients at a year postoperative showed there were no significant differences in the ectopic pregnancy rate,intrauterine pregnancy rate and intrauterine re-occlusion rate between the bilateral obstruction group(4%,40%,14%),the unilateral obstruction group(10%,30%,10%)and the bilateral obstruction group(4.55%,36.36%,13.64%)(P>0.05).Conclusions Hysteroscopy and laparoscopy combined with tubal catheterization interventional treatment for tubal infertility is of higher success rate of tubal intubation and tubal recanalization and fewer postoperative complications.Safe and efficient,it is worthy of clinical application.