宫腹腔镜联合治疗输卵管堵塞致不孕的疗效及对性激素水平的影响

The efficacy of hysteroscopy combined with laparoscopy in the treatment of infertility caused by tubal obstruction and its effect on sex hormone levels

目的:探讨宫腹腔镜联合治疗输卵管堵塞(TO)致不孕的疗效及对性激素水平的影响。方法:选择浙江新安国际医院2017年1月至2019年3月收治的78例TO致不孕患者为研究对象,根据不同术式分为治疗组40例(接受宫腹腔镜联合治疗)和对照组38例(接受宫腔镜治疗)。观察两组手术相关指标、输卵管通畅及1年内妊娠情况,手术前后测定血清性激素及应激反应指标并进行比较。结果:治疗组手术时间长于对照组[(45.17±8.76)min比(34.01±6.25)min],差异有统计学意义(P<0.05)。两组术中出血量、术后排气时间、住院时间及并发症发生率比较差异无统计学意义(P>0.05)。两组术后血清雌二醇(E 2)、卵泡生成激素(FSH)、黄体生成激素(LH)、皮质醇(Cor)、超敏-C反应蛋白(hs-CRP)水平较术前均上升,促甲状腺激素(TSH)水平较术前下降,差异有统计学意义(P<0.05);治疗组术后Cor、hs-CRP水平均低于对照组[(22.19±7.32)mg/L比(33.05±8.24)mg/L、(7.28±2.63)mg/L比(11.89±3.84)mg/L],E 2、FSH、LH、TSH水平高于对照组[(181.48±21.24)ng/L比(136.00±19.56)ng/L、(30.51±5.76)U/L比(24.84±6.0)U/L、(34.62±6.57)U/L比(29.37±7.25)U/L、(3.12±0.65)mU/L比(1.93±0.54)mU/L],差异有统计学意义(P<0.05);治疗组输卵管完全通畅率、1年内宫内妊娠率均高于对照组[92.50%(37/40)比76.32%(29/38)、75.00%(30/40)比52.63%(20/38)],差异有统计学意义(P<0.05)。结论:宫腹腔镜联合治疗TO致不孕疗效较好,能有效促输卵管再通,改善性激素水平,减轻患者应激反应,提高妊娠率。

Objective To explore the efficacy of hysteroscopy combined with laparoscopy in the treatment of infertility caused by tubal obstruction(TO)and its effect on sex hormone levels.Methods According to different surgical methods,78 infertile patients caused by TO admitted from January 2017 to March 2019 in Zhejiang Xin′an International Hospital were divided into the treatment group(40 cases)and the control group(38 cases).The patients in the treatment group were treated with hysteroscopy combined with laparoscopy,and the patients in the control group were treated with hysteroscopy.The indicators related to the operation,unobstructed fallopian tube and pregnancy in 1 year in the two groups were compared.Serum sex hormones and stress response indicators were measured before and after the operation.Results The operation time in the treatment group was(45.17±8.76)min,which was significantly longer than that in the control group(34.01±6.25)min,and the difference was statistically significant(P<0.05).There was no significant differences in intraoperative blood loss,postoperative exhaust time,hospital stay and complication rate between the two groups(P>0.05).After operation,the levels of serum estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),cortisol(Cor)and hypersensitive C-reactive protein(hs-CRP)in the two groups increased significantly(P<0.05),while thyroid stimulating hormone(TSH)levels decreased significantly(P<0.05).After operation,the levels of Cor and hs-CRP in the treatment group were lower than those in the control group[(22.19±7.32)mg/L vs.(33.05±8.24)mg/L,(7.28±2.63)mg/L vs.(11.89±3.84)mg/L],while the levels of E2,FSH,LH and TSH in the treatment group were higher than those in the control group[(181.48±21.24)ng/L vs.(136.00±19.56)ng/L,(30.51±5.76)U/L vs.(24.84±6.0)U/L,(34.62±6.57)U/L vs.(29.37±7.25)U/L,(3.12±0.65)mU/L vs.(1.93±0.54)mU/L],and the differences were statistically significant(P<0.05).The rates of complete patency of fallopian tube and intrauterine pregnancy in 1 year in the treatment group were higher than those in the control group[92.50%(37/40)vs.76.32%(29/38),75.00%(30/40)vs.52.63%(20/38)],and the differences were statistically significant(P<0.05).Conclusions Hysteroscopy combined with laparoscopy in the treatment of infertility caused by TO is effective,and can effectively promote the recanalization of fallopian tube,improve the level of sex hormones,reduce the stress response of patients and improve the pregnancy rate.