【摘要】：目的:探討宮腹腔鏡聯(lián)合手術(shù)在女性不孕癥診斷治療價(jià)值以及術(shù)后妊娠結(jié)局的相關(guān)因素。方法:回顧性分析2008年1月~2014年5月因不孕癥在海軍總醫(yī)院行宮腹腔鏡聯(lián)合檢查和手術(shù)治療的患者461例,宮腹腔鏡下評(píng)估不孕癥病因、術(shù)后電話隨訪妊娠情況、妊娠結(jié)局,比較原發(fā)性不孕癥和繼發(fā)性不孕癥的妊娠率,觀察年齡和盆腔粘連程度對(duì)妊娠結(jié)局的影響。結(jié)果:461例不孕癥患者中,原發(fā)性不孕225例(48.8%),繼發(fā)性不孕236例(51.2%)。不孕癥的主要原因是盆腔粘連54.5%(251例)、輸卵管阻塞50.8%(234例)、子宮內(nèi)膜異位癥157例(34.1%)。盆腔粘連、輸卵管阻塞和宮腔粘連發(fā)生率繼發(fā)生不孕癥高于原發(fā)性不孕癥,生殖器結(jié)核僅發(fā)生于原發(fā)性不孕者,其他不孕因素兩者之間沒有統(tǒng)計(jì)學(xué)差異。術(shù)后隨訪率為85.25%。術(shù)后自然妊娠50.6%,原發(fā)性不孕患者的妊娠率為49.5%,繼發(fā)性不孕患者的妊娠率為51.8%,妊娠時(shí)間主要集中在術(shù)后1年內(nèi),足月分娩43.8%。20~30歲年齡組的妊娠率(54.9%)高于31~43歲組(45.5%)(P0.05)。無盆腔粘連、輕、中度粘連者和重度粘連者的妊娠率分別為61.5%、54.8%、40.6%和18.9%,無盆腔粘連者妊娠率和足月分娩率明顯高于盆腔粘連者(P0.05);盆腔粘連組中輕、中度粘連者妊娠率和足月分娩率與重度粘連者比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),輕度和中度粘連間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:宮腹腔鏡聯(lián)合手術(shù)能更加直觀的評(píng)估不孕癥病因,同時(shí)可針對(duì)病因進(jìn)行相應(yīng)治療,手術(shù)時(shí)間短、創(chuàng)傷小,能提高不孕患者的臨床妊娠率和足月分娩率,對(duì)女性不孕癥的診斷與治療有重要臨床價(jià)值。
[Abstract]:Objective: to investigate the value of combined hysteroscopy and laparoscopy in the diagnosis and treatment of female infertility and the related factors of postoperative pregnancy outcome. Methods: from January 2008 to May 2014, 461 patients with infertility underwent combined hysteroscopy and surgical treatment in Naval General Hospital were retrospectively analyzed. The etiology of infertility was evaluated under hysteroscopy, the pregnancy status and pregnancy outcome were followed up by telephone after operation. The pregnancy rates of primary infertility and secondary infertility were compared and the influence of age and pelvic adhesion on pregnancy outcome was observed. Results: 225 cases (48.8%) were primary infertility and 236 cases (51.2%) secondary infertility. The main causes of infertility were pelvic adhesion 54.5% (251 cases), tubal obstruction 50.8% (234 cases), endometriosis 157 cases (34.1%). The incidence of pelvic adhesion, tubal obstruction and uterine cavity adhesion followed by infertility was higher than that of primary infertility. Genital tuberculosis only occurred in patients with primary infertility, but there was no statistical difference between other infertility factors. The follow-up rate was 85.25%. The pregnancy rate of patients with primary infertility was 49.5%, and that of patients with secondary infertility was 51.8%. The pregnancy time was mainly concentrated within one year after operation. The pregnancy rate of the age group of 43.8.2020 + 30 years of term delivery was higher than that of the 31- 43-year-old group (45.5%) (P0.05). The pregnancy rates of patients without pelvic adhesion, mild and moderate adhesions and severe adhesions were 61.5% and 18.9%, respectively. The pregnancy rate and term delivery rate of patients without pelvic adhesions were significantly higher than those with pelvic adhesions (P0.05), while in pelvic adhesions group, the pregnancy rate and term delivery rate were significantly higher than those without pelvic adhesions (P0.05), while in pelvic adhesions group, the pregnancy rate was significantly higher than that in pelvic adhesions group (P 0.05). The pregnancy rate and term delivery rate of moderate adhesions were significantly higher than those of severe adhesions (P0.05), but there was no significant difference between mild and moderate adhesions (P0.05). Conclusion: combined hysteroscopy and laparoscopy can evaluate the etiology of infertility more intuitively, at the same time, it can treat the cause of infertility. The operation time is short, the trauma is small, and the clinical pregnancy rate and term delivery rate can be increased in infertile patients. It has important clinical value in the diagnosis and treatment of female infertility.
【作者單位】： 內(nèi)蒙古民族大學(xué)臨床醫(yī)學(xué)院;中國(guó)人民解放軍海軍總醫(yī)院生殖中心;
【分類號(hào)】：R711.6

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