选择性输卵管插管疏通术的临床疗效及影响因素分析

Clinical efficacy analysis of selective hydrotubation

关键词:  选择性输卵管插管疏通  不孕症  临床疗效

Key words:  selective hydrotubation  infertility  clinical efficacy

摘要:

目的 探讨选择性输卵管插管疏通术（selective hydrotubation，SHT）的临床疗效及其影响因素。方法 收集2015年6月至2019年6月行选择性输卵管插管疏通术治疗的58例诊断为输卵管近端阻塞患者的临床资料，包括不孕时间（<3年或≥3年）、不孕类型（原发或继发）、是否有支原体感染、输卵管阻塞数量和程度、是否患有其他妇科合并症以及手术方式，分析术后的临床疗效并对其影响因素进行单因素和多因素分析。结果 选择性输卵管插管疏通术疏通成功率97%，总妊娠率41.4%。已孕组24例，未孕组34例，单因素分析表明输卵管近端完全性阻塞的患者术后妊娠率高于不完全阻塞者（χ²=7.643，P=0.006），原发性不孕患者术后妊娠率高于继发性不孕者（χ²=5.170，P=0.023），而患者年龄、手术方式、生殖道感染、输卵管阻塞个数以及是否有其他妇科合并症不影响术后妊娠率（P>0.05）。与单因素分析相同，多因素分析表明输卵管近端完全性阻塞的患者术后妊娠率高于不完全阻塞者（OR=3.671，P=0.035），但不孕类型不影响术后妊娠率（P=0.395）。结论 选择性输卵管插管疏通治疗是治疗输卵管近端梗阻的有效方法，输卵管完全梗阻的病人术后更容易受孕。

Abstract:

Objective To study the influencing factors and clinical efficacy of selective hydrotubation (SHT). Methods We retrospectively analyzed the data of 58 patients with selective hydrotubation from June 2015 to June 2019, including time of infertility(less than 3 years or 3 years and above), type of infertility (primary or secondary), mycoplasma infection, number and degree of fallopian tube obstruction, other gynecological complications and the method of surgery. Clinical efficacy of surgery was analyzed. Univariate factor and multiple factor analyses were performed to identify the influencing factors. Results The success rate of SHT was 97% with a total pregnancy rate of 41.4%, including 24 cases in the pregnant group and 34 cases in the non-pregnant group. Univariate analysis revealed that the patients with complete tubal obstruction had better postoperative pregnancy rate than those with incomplete obstruction (χ²=7.643,P=0.006). The patients with primary infertility had better efficacy than those with secondary infertility (χ²=5.170,P=0.023). The patients' age, surgical method, type of infertility, reproductive tract infection, number of tubal obstructions, and presence/absence of other gynecological complications had no significant correlation with postoperative pregnancy rate (P>0.05). Similar to univariate analysis, multivariate analysis demonstrated that the patients with complete tubal obstruction had better postoperative pregnancy rates than those with incomplete obstruction (OR=3.671,P=0.035); however, the type of infertility did not affect postoperative pregnancy rates (P=0.395). Conclusion Selective hydrotubation is an effective method for the treatment of proximal tubal obstruction. Patients with complete tubal obstruction are more likely to conceive after surgery.