宫腔镜和腹腔镜联合治疗输卵管性不孕的临床分析

doi:10.3877/cma.j.issn.1673-5250.2013.01.009

目的

探讨宫腔镜和腹腔镜联合治疗输卵管性不孕的临床价值。

方法

选择2007年1月至2008年12月因输卵管性不孕于本院就诊并行宫腔镜和腹腔镜联合治疗的不孕症患者116例为研究对象。按术后是否妊娠，将其分为妊娠组(n＝43)和未孕组(n＝73)。分析术后自然妊娠率，输卵管、盆腔病变程度与妊娠率的关系及术后最佳妊娠时间等(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，并与受试者签署临床研究知情同意书)。妊娠组与未孕组患者年龄、不孕年限及孕产史比较，差异无统计学意义(P>0.05)。

结果

116例患者术后随访30个月，共计43例妊娠，妊娠率为37.07%。术后妊娠率与输卵管、盆腔病变严重程度有关，轻、中、重度患者术后妊娠率分别为54.05%(20/37)，42.11%(16/38)，17.07%(7/41)，3者间比较，差异有统计学意义(P<0.05)。术后1～6个月，7～12个月，13～18个月，19～24个月及25～30个月的妊娠率分别为13.79%(16/116)，12.07%(14/116)，8.62%(10/116)，2.59%(3/116)和0(0/116)，术后18个月内妊娠率为93.02%(40/43)。

结论

输卵管性不孕患者宫、腹腔镜联合治疗输卵管性不孕，术后妊娠率与输卵管、盆腔病变程度相关，病变轻者的术后妊娠率较高。经宫、腹腔镜联合治疗后，本组妊娠率患者于术后18个月内的妊娠率较高。

关键词: 宫腔镜手术, 腹腔镜手术, 输卵管性不孕

Objective

To investigate the clinical value of tubal infertility treated by hysteroscopy combined with laparoscopy (H-laparoscopy).

Methods

From January 2007 to December 2008, a total of 116 cases with tubal infertility were treated by H-laparoscopy and followed up. They were divided into pregnancy group (n=43) and non-pregnant group (n=73) according to if they were pregnant or not after the treatment. The natural pregnancy rate, relationship between tubal pelvic disease severity and natural pregnancy rate, best pregnancy time were studied. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Sichuan Maternal and Children's Hospital. Informed consent was obtained from all participates. There had no significant difference between pregnancy group and non-pregnant group on patient's age, duration of infertility and pregnancy history (P>0.05).

Results

One hundred and sixteen patients were followed up for 30 months, a total of 43 cases were pregnant. The natural pregnancy rate was 37.07%. Pregnancy rate was related with pelvic disease severity, that means, the pregnancy rate of mild, moderate and severe degree patients were 54.05% (20/37), 42.11%(16/38) and 17.07%(7/14), respectively, there had significant difference among three degrees (P<0.05). The pregnancy rate during 1-6 months, 7-12 months, 13-18 months, 19-24 months and 25-30 months after the operation were 13.79%(16/116), 12.07%(14/116), 8.62%(10/116), 2.59%(3/116), and 0(0/116). The pregnancy rate during 18 months after operation was 93.02%(40/43).

Conclusions

The pregnancy rate of tubal infertility after operation is related with tubal pelvic disease severity. The patient of mild degree have higher pregnancy rate in 18 months after operation.

Key words: hysteroscopy, laparoscopy, tubal infertility

表1 输卵管、盆腔病变分度标准

Table 1 Classification standards of tubal pelvic disease

分度	输卵管、卵巢周围粘连	输卵管纤维化、扩张	输卵管黏膜病变
轻度	局部、膜状	无	无
中度	局部、致密	单侧，扩张≤1.5 cm	单侧
重度	广泛、致密	双侧，扩张>1.5 cm	双侧

表1 输卵管、盆腔病变分度标准

Table 1 Classification standards of tubal pelvic disease

分度	输卵管、卵巢周围粘连	输卵管纤维化、扩张	输卵管黏膜病变
轻度	局部、膜状	无	无
中度	局部、致密	单侧，扩张≤1.5 cm	单侧
重度	广泛、致密	双侧，扩张>1.5 cm	双侧

表2 术后是否妊娠与患者年龄、不孕年限、孕产史的关系 (±s)

Table 2 Relationship between pregnancy rate and patients' age, length of infertility and pregnancy history (±s)

组别	n	年龄(岁)	不孕年限(年)	孕产史[n(%)]
组别	n	年龄(岁)	不孕年限(年)	原发性不孕	继发性不孕
妊娠组	43	29.56±4.93	3.63±2.50	13(30.23)	30(69.77)
未孕组	73	28.70±4.84	4.04±2.69	26(35.62)	47(64.38)
t/χ²	?	t＝0.918	t＝0.824	χ²＝0.351
P	?	0.361	0.414	0.553

表2 术后是否妊娠与患者年龄、不孕年限、孕产史的关系 (±s)

Table 2 Relationship between pregnancy rate and patients' age, length of infertility and pregnancy history (±s)

组别	n	年龄(岁)	不孕年限(年)	孕产史[n(%)]
组别	n	年龄(岁)	不孕年限(年)	原发性不孕	继发性不孕
妊娠组	43	29.56±4.93	3.63±2.50	13(30.23)	30(69.77)
未孕组	73	28.70±4.84	4.04±2.69	26(35.62)	47(64.38)
t/χ²	?	t＝0.918	t＝0.824	χ²＝0.351
P	?	0.361	0.414	0.553

表3 2组患者输卵管、盆腔病变程度比较[n(%)]

Table 3 Comparision of tubal pelvic disease severity between two groups [n(%)]

组别	n	轻度	中度	重度
妊娠组	43	20(46.51)	16(37.21)	7(16.28)
未孕组	73	17(23.29)	22(30.14)	34(46.58)
合计	116	37(31.90)	38(32.76)	41(35.34)

表3 2组患者输卵管、盆腔病变程度比较[n(%)]

Table 3 Comparision of tubal pelvic disease severity between two groups [n(%)]

组别	n	轻度	中度	重度
妊娠组	43	20(46.51)	16(37.21)	7(16.28)
未孕组	73	17(23.29)	22(30.14)	34(46.58)
合计	116	37(31.90)	38(32.76)	41(35.34)

表4 术后不同时间段妊娠率比较 (%)

Table 4 Comparison of pregnancy rate in each time after surgery (%)

术后时间(个月)	妊娠(n)	构成比	累计构成比	妊娠率	累计妊娠率
1～ 6	16	37.21	37.21	13.79	13.79
7～12	14	32.56	69.77	12.07	25.86
13～18	10	23.26	93.02	8.62	34.48
19～24	3	6.97	100.00	2.59	37.07
25～30	0	0.00	100.00	0.00	37.07
合计	43	100.00	100.00	37.07	37.07

表4 术后不同时间段妊娠率比较 (%)

Table 4 Comparison of pregnancy rate in each time after surgery (%)

术后时间(个月)	妊娠(n)	构成比	累计构成比	妊娠率	累计妊娠率
1～ 6	16	37.21	37.21	13.79	13.79
7～12	14	32.56	69.77	12.07	25.86
13～18	10	23.26	93.02	8.62	34.48
19～24	3	6.97	100.00	2.59	37.07
25～30	0	0.00	100.00	0.00	37.07
合计	43	100.00	100.00	37.07	37.07

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Clinical Analysis of Tubal Infertility Treated by Hysteroscopy Combined With Laparoscopy

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Clinical Analysis of Tubal Infertility Treated by Hysteroscopy Combined With Laparoscopy