發(fā)布時(shí)間：2018-05-17 00:41

  本文選題：不孕癥 + 宮腔鏡��； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的：分析女性不孕癥的病因及宮腔鏡和腹腔鏡聯(lián)合診治女性不孕癥的臨床效果，并探討影響術(shù)后自然妊娠的相關(guān)因素。 方法：回顧性分析2010年5月至2012年4月在我院（同濟(jì)大學(xué)附屬第一婦嬰保健院）住院行宮、腹腔鏡聯(lián)合診治術(shù)的女性不孕癥患者的臨床資料，通過門診復(fù)診記錄和電話隨訪其術(shù)后妊娠情況，并進(jìn)一步統(tǒng)計(jì)輸卵管性不孕癥的術(shù)后自然妊娠率及其影響因素。 結(jié)果：（1）本研究共收集到457例患者（隨訪到338例，失訪119例，失訪率為26.04%），其中雙側(cè)輸卵管堵塞221例（48.36%），單側(cè)輸卵管阻塞92例（20.13%）；子宮內(nèi)膜異位癥111例（包括卵巢內(nèi)膜樣囊腫81例，盆腔腹膜內(nèi)異癥30例），多囊卵巢綜合征（polycystic ovarian syndrome,PCOS）30例，卵巢良性腫瘤10例；子宮肌瘤31例，子宮縱隔16例，宮腔粘連17例，子宮內(nèi)膜息肉31例，雙子宮、雙宮頸畸形3例；肝周圍炎(Fitz Hugh Curtis syndrome,FHCS)16例；不明原因16例。手術(shù)并發(fā)癥發(fā)生率為：0.44%，，患者的平均住院費(fèi)用為1.13萬(wàn)元。（2）宮腹腔鏡聯(lián)合手術(shù)的術(shù)后自然妊娠率為41.10%，其中67.16%發(fā)生在術(shù)后6個(gè)月內(nèi)；異位妊娠（均是輸卵管妊娠）率為3.07%。術(shù)后接受體外受精-胚胎移植（In vitro fertilization-embryo transfer，IVF-ET）治療的患者為103例，成功率為45.63%，異位妊娠率為3.88%。其中，輸卵管切除組（n=23）IVF-ET的成功率為65.21%（15/23），輸卵管保留組（n=80）IVF-ET的成功率為40.00%(32/80)，p=0.036，差異有統(tǒng)計(jì)學(xué)意義。經(jīng)手術(shù)和IVF-ET綜合治療的總?cè)焉锫蕿?3.55%（181/338）。（3）本研究隨訪到單純輸卵管性不孕癥177例，其術(shù)后自然妊娠率為40.11%（71/177），其中70.42%發(fā)生于術(shù)后6個(gè)月內(nèi)（50/71）；異位妊娠率為3.39%（6/177）。輸卵管性不孕癥患者的術(shù)后自然妊娠率與不孕時(shí)間呈顯著負(fù)相關(guān)（β=-0.178，P0.05），而與年齡和不孕癥類型無(wú)關(guān)。（4）子宮內(nèi)膜異位癥Ⅲ/Ⅳ（單側(cè)或雙側(cè)卵巢內(nèi)膜樣囊腫3cm~7cm）的術(shù)后自然妊娠率為42.65%（29/68）；其中有15例在術(shù)后又行IVF-ET治療，成功妊娠6例，成功率40%；綜合治療后的妊娠率為51.47%（35/68）。（5）PCOS的不孕癥患者行腹腔鏡下卵巢打孔術(shù)，并術(shù)后予克羅米芬促排治療，妊娠率為53.85%（14/26）。（6）子宮不全縱隔的不孕癥患者行宮腔鏡下子宮縱隔剪開+通液+放環(huán)術(shù)，并于術(shù)后3個(gè)月行宮腔鏡下取環(huán)+通液術(shù)，術(shù)后自然妊娠率為76.92%（10/13）。 結(jié)論：（1）輸卵管性因素是導(dǎo)致女性不孕癥的主要原因；（2）宮、腹腔鏡聯(lián)合診治術(shù)對(duì)女性不孕癥的診斷和治療均具有臨床應(yīng)用價(jià)值，并且其并發(fā)癥發(fā)生率低，費(fèi)用低，值得推廣應(yīng)用；術(shù)后半年內(nèi)的自然妊娠率較高，如果術(shù)后1年未能自然妊娠再行輔助生殖技術(shù)治療可以提高總的妊娠率；（3）宮腹腔鏡聯(lián)合手術(shù)治療輸卵管性不孕癥患者的術(shù)后自然妊娠率與不孕時(shí)間呈顯著負(fù)相關(guān)，即不孕時(shí)間越長(zhǎng)術(shù)后自然妊娠的可能性越小。
[Abstract]:Objective: to analyze the etiology of female infertility and the clinical effect of hysteroscopy combined with laparoscopy in the diagnosis and treatment of female infertility. Methods: the clinical data of female infertility patients who were hospitalized in our hospital from May 2010 to April 2012 were analyzed retrospectively. The postoperative pregnancy rate of tubal infertility and its influencing factors were analyzed by follow-up records and telephone follow-up. Results A total of 457 patients (338 cases followed up, 119 cases missing) were collected in this study. The missing rate was 26.040.221 cases had bilateral tubal obstruction, 92 cases had unilateral fallopian tube obstruction, 111 cases had endometriosis (including 81 cases of ovarian endometrioid cysts) There were 30 cases of pelvic intraperitoneal heterosis, 30 cases of polycystic ovarian syndrome (PCOS), 10 cases of benign ovarian tumor, 31 cases of uterine myoma, 16 cases of uterine mediastinum, 17 cases of intrauterine adhesion, 31 cases of endometrial polyp, 3 cases of double uterus and 3 cases of cervical malformation. There were 16 cases of Curtis Hugh and 16 cases of unknown cause of perihepatic inflammation. The incidence of postoperative complications was: 1: 0.44, the average hospitalization cost of the patients was 11300 yuan. The rate of spontaneous pregnancy was 41.1010, 67.16% of which occurred within 6 months after operation, and the rate of ectopic pregnancy (all tubal pregnancy) was 3.07. 103 patients were treated with in vitro fertilization-embryo transfer IVF-ET. the success rate was 45.63 and the ectopic pregnancy rate was 3.88. The success rate of IVF-ET in salpingotomized group was 65.21 / 23, and the success rate of IVF-ET in fallopian tube retention group was 40.002 / 80 / 0.036. The difference was statistically significant. The total pregnancy rate after operation and combined treatment with IVF-ET was 53.55 / 181 / 338.The study followed up 177 cases of simple oviductal infertility. The postoperative natural pregnancy rate was 40.1171 / 177g, 70.42% of which occurred within 6 months after operation and 50 / 71a; the ectopic pregnancy rate was 3.396177m. The spontaneous pregnancy rate of oviductal infertility patients was negatively correlated with the duration of infertility (尾 -0.178U P0.05, but not with age and type of infertility). Endometriosis 鈪

本文編號(hào)：1899147