宫腹腔镜联合治疗输卵管性不孕症的效果

李开颜 沈慧敏

[摘要]目的 探究宫腔镜联合腹腔镜治疗输卵管性不孕症的效果。方法 选取2015年1月～2016年12月广东省潮州市潮安区人民医院和中山大学附属第一医院收治的输卵管性不孕症患者共189例，依据就诊顺序分为腹腔镜组（n=94）与宫腹腔镜组（n=95），腹腔镜组患者单纯接受腹腔镜治疗，宫腹腔镜组患者接受宫腔镜联合腹腔镜治疗。治疗结束后随访1年，比较两组患者手术时间、术中出血量、输卵管疏通率及妊娠率等指标。结果 腹腔镜组患者手术时间显著长于腹腔镜组，但中出血量显著低于腹腔镜组，差异均有统计学意义（P<0.05）。两组患者术前、术后PaCO2、SaO2的比较，差异无统计学意义（P>0.05）。宫腹腔镜组患者的疏通率显著高于腹腔镜组，差异有统计学意义（P<0.05）。宫腹腔镜组6、12个月妊娠率显著高于腹腔镜组，差异均有统计学意义（P<0.05）。两组患者并发症发生率的比较，差异无统计学意义（χ2=0.7098，P>0.05）。結论 宫腔镜联合腹腔镜治疗输卵管性不孕症有较好的临床效果，安全可靠，术后输卵管疏通率及妊娠率高，值得临床推广应用。

[关键词]宫腔镜；腹腔镜；输卵管性不孕症

[中图分类号] R711.6 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0117-03

[Abstract]Objective To explore the effect of hysteroscopy combined with laparoscopy in the treatment of tubal infertility.Methods From January 2015 to December 2016，189 patients with tubal infertility were selected from People′s Hospital of Chao an District of Chaozhou City in Guangdong Province，and the First Affiliated Hospital of Sun Yat-sen University，the patients were divided into laparoscopic group （n=94） and hysteroscopy group （n=95） according to the order of treatment.The patients in laparoscopic group were treated by laparoscopy alone，and the patients in hysteroscopy group were treated by hysteroscopy combined with laparoscopy.After 1 year follow-up，the operation time，intraoperative blood loss，tubal patency rate and pregnancy rate were compared between the two groups.Results The operation time in laparoscopic group was significantly longer than that in laparoscopic group，but the bleeding volume in laparoscopic group was significantly lower than that in laparoscopic group，the difference was statistically siginificant （P<0.05）.There was no significant difference in PaCO2 and SaO2 between the two groups（P>0.05）.The dredging rate of hysteroscopy group was significantly higher than that of laparoscopy group，the difference was statistically siginificant （P<0.05）.The pregnancy rate of 6，12 months in laparoscopy group was significantly higher than that in laparoscopy group，the difference was statistically siginificant （P<0.05）.There was no significant difference between the two groups（χ2=0.7098，P>0.05）.Conclusion Hysteroscopy combined with laparoscopy has good clinical effect in the treatment of tubal infertility.It is safe and reliable.Postoperative tubal dredging rate and pregnancy rate are high，which is worthy of clinical application.

[Key words]Hysteroscopy；Laparoscopy；Tubal factor infertility

输卵管性不孕（tubal factor infertility，TFI）是由于各种因素导致的输卵管管壁收缩功能或上皮纤毛蠕动减弱造成的粘连、积水或阻塞等，具有发病率高、病因多样、疗效欠佳等特点[1]。随着社会生活方式转变，不育不孕人口占已婚夫妻的7%～15%[1]，据相关文献显示[2-3]，有25%～40%的不孕症患者是由于输卵管因素造成的，另一方面，随着晚婚晚育、人工流产次数增加、性疾病的增加，输卵管性不孕的发生率有所增加。输卵管性不孕的治疗方式主要有输卵管通液、子宫输卵管造影、宫腔镜插管通液等。本研究主要观察宫腔镜联合腹腔镜治疗输卵管性不孕的临床效果，研究表明[4]，宫腹腔镜联合治疗TFI的妊娠率可达到28%～53%，但治疗效果也受到盆腔粘连、输卵管病变程度的影响。……