盆腔子宫内膜异位症对输卵管近端阻塞不孕患者行宫腹腔镜联合插管术治疗效果的影响

Impact of Endometriosis on the Therapeutic Effect of Hysteroscopic Fallopian Tube Catheterization Combined With Laparoscopy in Infertile Patients With Proximal Tubal Obstruction

目的探讨盆腔子宫内膜异位症(内异症)对输卵管近端阻塞不孕患者行宫腹腔镜联合插管术治疗效果的影响。方法回顾性分析四川大学华西第二医院生殖内分泌科2016年1月19日-2020年3月20日因输卵管近端阻塞不孕行宫腹腔镜联合输卵管插管疏通手术的患者,术中行通液术确定输卵管近端阻塞,根据合并内异症与否,分为内异症组和非内异症组。运用倾向性得分匹配的方法平衡基线数据,统计输卵管近端阻塞不孕患者在宫腹腔镜联合输卵管插管术后的手术疏通率。根据意向性分析的原则,将两组失访的病例均作为未妊娠处理,随访术后的妊娠结局。主要指标包括手术疏通率、临床妊娠率、自然妊娠率,次要指标包括活产率、流产率、异位妊娠率及妊娠间隔时间。结果倾向性得分匹配后,两组各纳入113例,总体疏通率为72.6%,内异症组患者的手术疏通率高于非内异症组,差异有统计学意义(78.8%vs.66.4%,P<0.05)。随访匹配后患者共计失访38例。术后随访至今并经意向性分析后,发现内异症组的自然妊娠率高于非内异症组(44.2%vs.30.1%,P<0.05),术后平均自然妊娠间隔时间更短(46个月vs.53个月,P<0.05)。内异症组与非内异症组在临床妊娠率、活产率、流产率、异位妊娠率的差异均无统计学意义(P>0.05)。结论输卵管近端阻塞不孕患者若合并内异症,选择宫腹腔镜联合插管术,有益于改善生育结局。

Objective To investigate the impact of endometriosis on the therapeutic effect of hysteroscopic fallopian tube catheterization combined with laparoscopy in infertile patients with proximal tubal obstruction.Methods We conducted a retrospective analysis of patients who underwent hysteroscopic fallopian tube catheterization combined with laparoscopy for infertility caused by proximal fallopian tube obstruction between January 19,2016 and March 20,2020 at the Department of Reproductive Endocrinology,West China Second Hospital,Sichuan University.During the operation,hydrotubation was performed to verify whether there was proximal tubal obstruction.Then,the patients were categorized into an endometriosis group and a non-endometriosis group according to whether their proximal tubal obstruction was combined with endometriosis.The baseline data were balanced by propensity score matching and the rate of successful surgical unblocking of proximal tubal obstruction in infertile patients by hysteroscopic fallopian tube catheterization combined with laparoscopy was calculated.Treating cases lost to follow-up in both groups as non-pregnant cases according to the principle of intention-to-treat analysis,we followed up the pregnancy outcomes after surgery.The primary indicators included overall successful surgical unblocking rate,clinical pregnancy rate,and spontaneous pregnancy rate,while the secondary indicators included live birth rate,miscarriage rate,ectopic pregnancy rate,and the mean time to spontaneous pregnancy after surgery.The primary indicators included overall successful surgical unblocking rate,clinical pregnancy rate,and spontaneous conception rate,while the secondary indicators included live birth rate,miscarriage rate,ectopic pregnancy rate,and the mean time to spontaneous pregnancy after surgery.Results After propensity score matching,113 cases were included in each of the two groups,with the overall successful surgical unblocking rate being 72.6%.The successful surgical unblocking rate of patients in the endometriosis group was higher than that of the non-endometriosis group,with the difference being statistically significant(78.8%vs.66.4%,P<0.05).A total of 38 patients were lost after follow-up matching.Postoperative follow-up was performed to date and,through intention-to-treat analysis,the spontaneous conception rate was found to be higher in the endometriosis group than that in the non-endometriosis group(44.2%vs.30.1%,P<0.05),while the mean time to spontaneous pregnancy after surgery was shorter in the endometriosis group than that in the non-endometriosis group(46 months vs.53 months,P<0.05).There was no significant difference in clinical pregnancy rate,live birth rate,miscarriage rate,and ectopic pregnancy rate between the endometriosis group and the non-endometriosis group(P>0.05).Conclusion When infertility caused by proximal tubal obstruction is combined with endometriosis,performing hysteroscopic fallopian tube catheterization combined with laparoscopy contributes to the improvement of reproduction outcomes.