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目的探讨腹腔镜联合输卵管手感插管疏通术在输卵管性不孕症治疗中的应用价值。方法回顾性分析2008年4月18日至2010年6月19日期间收治的125例输卵管性不孕患者,采用腹腔镜联合输卵管手感插管疏通术,进行腹腔镜检术、盆腔粘连分离术、输卵管周围粘连分离术、输卵管伞端成形术、新式输卵管切开术、腹腔镜监视下输卵管手感插管通液术。结果腹腔镜检将125例患者分为A、B、C三类。A类为轻度盆腔粘连;B类为慢性输卵管炎、中度盆腔粘连;C类为重度盆腔炎及输卵管炎。腹腔镜联合输卵管手感插管疏通术后,输卵管完全阻塞由术前128条(52.03%)下降到75条(30.49%),部分阻塞由术前110条(44.72%)下降到86条(34.96%),完全通畅由术前8条(3.25%)上升到85条(34.55%)。经统计学处理,差异有统计学意义,分别为P<0.01,P<0.05,P<0.01。125例术后≥6个月的97例随访者中有36例受孕,妊娠率为37.11%(36/97)。34例为宫内妊娠,2例为宫外妊娠。其中A类组宫内孕为24例(60.00%),宫外孕0例;B类组宫内孕10例(33.33%),宫外孕2例(6.67%),而C类组无一例妊娠。结论应用腹腔镜联合输卵管手感插管疏通术能直观、准确地明确输卵管病因并予以针对性治疗,直视下通液,动态观察输卵管通畅度和形态,因而是输卵管性不孕的有效治疗方法。
Objective To investigate the value of laparoscopic combined tubal hand catheterization in the treatment of tubal infertility. Methods Retrospective analysis of 125 patients with tubal infertility who were treated between April 18, 2008 and June 19, 2010 was performed with laparoscopy combined with tubal hand catheterization to clear laparoscopic surgery, pelvic adhesions separation, Fallopian tube adhesions around the fallopian tube umbrella endoplasty, the new fallopian tube incision, laparoscopic salpingoidectomy fluid tube surgery. Results Laparoscopy 125 patients were divided into A, B, C three categories. Class A was mild pelvic adhesions; Class B was chronic salpingitis, moderate pelvic adhesions; Class C was severe pelvic inflammatory disease and salpingitis. Laparoscopy combined with tubal hand catheterization decreased the total obstruction of the fallopian tube from preoperative 128 (52.03%) to 75 (30.49%), and partial obstruction decreased from 110 (44.72%) preoperatively to 86 (34.96% ). The complete patency increased from 8 (3.25%) preoperatively to 85 (34.55%) preoperatively. After statistical analysis, the difference was statistically significant (P <0.01, P <0.05, P <0.01). Of the 97 follow-up cases with more than 6 months after operation, 36 were pregnant and the pregnancy rate was 37.11% 36/97). 34 cases of intrauterine pregnancy, 2 cases of ectopic pregnancy. There were 24 cases (60.00%) of intrauterine pregnancy in group A, 0 cases of ectopic pregnancy in group A, 10 cases (33.33%) of intrauterine pregnancy in group B, and 2 cases (6.67%) in ectopic pregnancy. Conclusions Laparoscopy combined with tubal hand catheterization can intuitively and accurately identify the cause of tubal disease and give it targeted treatment. It can directly observe the fluid flow and observe the tubal patency and morphology dynamically, which is an effective treatment for tubal infertility.