本文關(guān)鍵詞： 不孕 輸卵管妊娠 輸卵管開窗取胚術(shù) 輸卵管切除術(shù) 腹腔鏡檢查術(shù) 宮腔鏡檢查術(shù)　出處：《中國實用婦科與產(chǎn)科雜志》2015年12期 　論文類型：期刊論文

【摘要】：目的探討輸卵管妊娠患者經(jīng)輸卵管開窗取胚術(shù)和切除術(shù)后繼發(fā)不孕的原因及輸卵管受損情況。方法收集2008年12月至2010年10月在武警后勤學院附屬醫(yī)院住院治療,既往有輸卵管妊娠、經(jīng)輸卵管開窗取胚術(shù)或切除術(shù)病史的不孕患者130例。根據(jù)既往輸卵管妊娠手術(shù)方式分為開窗取胚組(37例)和切除組(93例)。采用腹腔鏡觀察盆腔粘連程度、輸卵管形態(tài)、輸卵管傘端等情況;并在腹腔鏡監(jiān)護下行宮腔鏡下輸卵管口插管通液,觀察輸卵管管腔是否通暢。結(jié)果 94.62%患者存在輸卵管性不孕因素,包括宮腔及輸卵管形態(tài)異�；蛑車尺B、傘端閉鎖、管腔堵塞,至少有1個或多個因素合并存在;盆腔粘連發(fā)生率91.54%。兩組患者無妊娠史的輸卵管形態(tài)異常在開窗取胚組發(fā)生率為62.16%,在切除組為48.39%;傘端閉鎖或積水在開窗取胚組為62.16%,在切除術(shù)組為44.09%;管腔堵塞在開窗取胚組為81.08%,在切除術(shù)組為82.80%,兩組間差異均無統(tǒng)計學意義(P0.05)。盆腔粘連程度方面,Ⅰ、Ⅱ、Ⅲ度粘連發(fā)生率在開窗取胚組分別為21.62%、32.43%、35.14%,在切除組分別為29.03%、27.96%、33.33%,兩組在粘連發(fā)生率、發(fā)生程度上差異均無統(tǒng)計學意義(P0.05)。開窗取胚組有妊娠史和無妊娠史的輸卵管形態(tài)異常發(fā)生率分別為48.65%和62.16%,傘端閉鎖或積水發(fā)生率為45.95%和62.16%,管腔通暢發(fā)生率為24.32%和18.92%,差異無統(tǒng)計學意義(P0.05)。結(jié)論輸卵管妊娠開窗取胚術(shù)后的不孕患者,不孕的主要原因為輸卵管因素和盆腔粘連,包括輸卵管形態(tài)異常及周圍粘連和傘端異常、管腔堵塞。輸卵管開窗取胚術(shù)和切除術(shù)對無妊娠史的輸卵管形態(tài)、傘端異常和管腔通暢度影響無明顯區(qū)別。在開窗取胚術(shù)后不孕患者中,保留的患側(cè)輸卵管與無妊娠史的輸卵管受損無明顯差異。
[Abstract]:Objective to investigate the causes of secondary infertility and damage of fallopian tube in patients with tubal pregnancy after tubal fenestration and resection. Methods from December 2008 to October 2010, the patients were hospitalized in the affiliated Hospital of Armed Police Logistics College. 130 infertile patients with previous history of tubal pregnancy, embryo extraction or resection through tubal fenestration. According to the previous procedure of tubal pregnancy, 37 cases were divided into fenestration group (n = 37) and resection group (n = 93). The degree of pelvic adhesion was observed by laparoscopy. The shape of fallopian tube, the end of fallopian tube, and so on, were observed under hysteroscopy under laparoscope to observe whether the tubal cavity was unobstructed. Results 94.62% patients had infertility of fallopian tube. Including abnormal shape of uterine cavity and fallopian tube or adhesions around, atresia at the end of the umbrella, obstruction of the lumen, at least one or more factors exist. The incidence of pelvic adhesion was 91.54.The incidences of abnormal tubal morphology without pregnancy in the two groups were 62.16 in the fenestration group and 48.39 in the excision group; 62.16 in the open window group and 44.09 in the resection group; and in the fenestration group in the umbrella end atresia group and 44.09% in the resection group. 81.08% in embryo group and 82.80% in excision group. There was no significant difference between the two groups in the degree of pelvic adhesion. The incidences of 鈪，

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