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目的:探讨宫腔镜与腹腔镜联合治疗复杂性输卵管阻塞的临床效果。方法:回顾性分析2011年5月~2012年3月新疆医科大学附属中医院150例复杂性输卵管阻塞患者的临床资料,将患者按所选术式不同分为宫腔镜组和宫腹腔镜联合组,宫腔镜组103例(197条输卵管)单用宫腔镜治疗,宫腹腔镜联合组47例(92条输卵管)采用宫腔镜与腹腔镜联合治疗,比较两组患者手术效果及术后2年妊娠情况。结果:宫腔镜组197条输卵管成功再通168条,再通率85.28%,术后2个月再阻塞26条,再阻塞率15.48%;宫腹腔镜联合组92条输卵管成功再通87条,再通率94.57%,术后2个月再阻塞12条,再阻塞率13.79%;宫腹腔镜联合组再通率显著高于宫腔镜导丝组(P<0.05),再阻塞率两组无统计学差异(P>0.05)。宫腔镜组103例患者经超声诊断,42例宫内妊娠,妊娠率40.78%,5例输卵管妊娠,输卵管妊娠率4.85%;宫腹腔镜联合组47例患者经超声诊断,28例宫内妊娠,妊娠率59.57%,2例输卵管妊娠,输卵管妊娠率4.26%;宫腹腔镜联合组妊娠率显著高于宫腔镜组(P<0.05),输卵管妊娠率两组无统计学差异(P>0.05)。结论:宫腔镜与腹腔镜联合可弥补单独治疗的不足,对于提高输卵管再通率和术后妊娠率具有重要意义,是治疗复杂性输卵管阻塞的理想方法。
Objective: To explore the clinical effect of hysteroscopy combined with laparoscopy in the treatment of complicated tubal obstruction. Methods: A retrospective analysis of clinical data of 150 patients with complicated tubal occlusion in the Affiliated Chinese Medicine Hospital of Xinjiang Medical University from May 2011 to March 2012 was performed. The patients were divided into hysteroscopic group and laparoscopic combined with hysteroscopy Group, hysteroscopy group of 103 cases (197 tubal) with hysteroscopy alone, hysteroscopy combined group of 47 cases (92 tubal) with hysteroscopy and laparoscopy combined treatment, the two groups were compared the effect of surgery and surgery After 2 years of pregnancy. Results: A total of 168 hysteroscopic tubal tubes were successfully reconstructed, with an average recanalization rate of 85.28%. 26 of them were obstructed again two months after the hysteroscopic operation and the rate of reocclusion was 15.48% , And the recurrence rate was 94.57%. After 2 months, the number of reocclusion was 12 and the rate of reocclusion was 13.79%. The recanalization rate of hysteroscopy combined with hysteroscopy was significantly higher than that of hysteroscopy (P <0.05) There was no significant difference between the two groups (P> 0.05). Hysteroscopic group of 103 patients diagnosed by ultrasound, 42 cases of intrauterine pregnancy, the pregnancy rate was 40.78%, 5 cases of tubal pregnancy, tubal pregnancy rate was 4.85%; Palace laparoscopic combined group of 47 patients diagnosed by ultrasound, 28 cases of intrauterine pregnancy , Pregnancy rate was 59.57%, tubal pregnancy in 2 cases and tubal pregnancy rate was 4.26%. Pregnancy rate in hysterosalpingography group was significantly higher than that in hysteroscopy group (P <0.05), tubal pregnancy rate was no significant difference between the two groups (P> 0.05 ). Conclusion: The combination of hysteroscopy and laparoscopy can make up for the deficiency of single therapy, which is of great significance for improving the recanalization rate of tubal and the rate of postoperative pregnancy. It is an ideal method for the treatment of complicated tubal occlusion.