宫腔镜联合腹腔镜行输卵管修复整形术治疗输卵管性不孕的疗效分析

Analysis of the curative effect of tubal infertility treated by hysteroscopy combined with laparoscopy

关键词:  宫腔镜联合腹腔镜  输卵管修复整形术  输卵管性不孕

Key words:  hysteroscopy combined with laparoscopy  tubal repair and plastic surgery  tubal infertility

摘要:

目的 探讨宫腔镜联合腹腔镜下输卵管修复整形术治疗输卵管性不孕（tubal factor infertility，TFI）的疗效。方法 对213例行宫腔镜联合腹腔镜下输卵管修复整形手术治疗的患者进行输卵管评分分期，其中Ⅰ期35例，Ⅱ期78例，Ⅲ期64例，Ⅳ期36例。观察TFI患者术后感染情况，平均住院时间，并比较输卵管复通率及妊娠结局。结果 不同分期的患者术后感染情况两两比较，差异有统计学意义（P<0.05）；各期患者术后住院时间差异无统计学意义（P>0.05）。各期术后输卵管评分均明显低于术前，差异有统计学意义（P<0.001）。术后不同分期的输卵管评分比较，差异有统计学意义，且经两两多重比较，分期越高，术后输卵管评分越高，各期间差异均有统计学意义（P<0.001）。各期患者术后输卵管复通情况比较，分期越高，术后复通率越差，差异有统计学意义（P<0.001）。各期患者妊娠率比较，分期越高，术后妊娠率越低，各期患者两两比较，差异有统计学意义，P均<0.001。结论 TFI患者通过宫腔镜联合腹腔镜手术治疗，可明显提高患者的输卵管复通率，增加患者自然妊娠率。

Abstract:

Objective To investigate the effect of hysteroscopy combined with laparoscopic fallopian tube repair and plastic surgery in the treatment of tubal factor infertility (TFI). Methods Tube score staging was performed on 213 patients who underwent hysteroscopy combined laparoscopic fallopian tube repair and plastic surgery, including Ⅰ stage 35 cases, Ⅱ stage 78 cases, Ⅲ stage 64 cases, and Ⅳ stage 36 cases. The postoperative infection of TFI patients was observed. The average length of hospital stay, the rate of fallopian tube recanalization and pregnancy outcome were compared. Results Pairwise comparison of postoperative infection in patients with different stages showed statistically significant differences (P<0.001). There was no statistically significant difference in postoperative hospital stay among the patients (P>0.05). The score of fallopian tube after operation in each stage was significantly lower than that before operation, and the difference was statistically significant (P<0.001). Comparison of postoperative tubal scores of different stages showed statistically significant differences. Moreover, after multiple comparisons, the higher the stages were, the higher the postoperative tubal scores were, and the differences in each period were statistically significant (P<0.001). The higher the stage was, the worse the postoperative tubal recanalization rate was, and the difference was statistically significant (P<0.001). The higher the stage was, the lower the postoperative pregnancy rate was, and the difference was statistically significant (P<0.001). Conclusion Hysteroscopy combined with laparoscopic surgery can significantly improve the rate of fallopian tube recanalization and increase the rate of natural pregnancy in TFI patients.