输卵管再通术与电视腹腔镜联合治疗输卵管阻塞所致不孕症的临床分析  

Infertilitas Feminis Caused by Salpingemphraxis： Therapy with Oviduct Recanalization Combined with Video--Laparoscope

作　　者：代新学[1] 范雪梅[2] 任超峰[1] 周丹[2] 游海燕[3] 康旭[1] 粟惠君[1] 

机构地区：[1]四川省内江市第一人民医院放射科,四川内江641000 [2]四川省内江市第一人民医院妇产科,四川内江641000 [3]四川省内江市第一人民医院外科,四川内江641000

出　　处：《实用放射学杂志》2009年第6期881-884,共4页Journal of Practical Radiology

摘　　要：目的分析输卵管再通术与电视腹腔镜联合治疗输卵管（多段）阻塞所致不孕症的临床应用价值。方法经输卵管造影或／和选择性输卵管造影选择单侧或双侧输卵管伞端粘连合并同侧输卵管其它段阻塞患者67例作为研究对象，一般选择输卵管再通术后2～3d行电视腹腔镜对伞端粘连分离，必要时行输卵管成形、造口术。准确统计输卵管再通率、联合再通率、妊娠率以及官外孕、输卵管再次阻塞并发症的发生率。结果本组67例127条输卵管阻塞均成功实施输卵管再通术与电视腹腔镜联合治疗微创手术，其中，单纯输卵管再通率（前三段）97．6％（124／127），再通术与电视腹腔镜联合治疗再通率为96．0％（122／127），术后1年内妊娠率为58．2％（39／67），宫外孕发生率4．5％（3／67）。术后1年未受孕患者28例，其中27例患者再次行普通输卵管造影，10例输卵管各段通畅，占14．9％（10／67）；17例输卵管再次阻塞，再次阻塞率25．4％（17／67），其中伞端粘连积水13例，占19．4％（13／67），输卵管其它各段阻塞4例，占6．0％（4／67）。另外1例因确诊生殖道结核而放弃该治疗。结论输卵管再通术与电视腹腔镜联合治疗对输卵管阻塞所致不孕症的治疗是～种有效治疗手段。Objective To explore the clinical value of oviduct recanalization in combination with video--laparoscope in the treatment of infertilitas feminis caused by salpingemphraxis. Methods Sixty--seven patients with adherences in one or two fimbriated extremities of fallopian complicated with homolat oviduct obstruction in other segments, which were confirmed by means of salpingography or selective salpingography, were involved in this study. All patients underwent oviduct recanalization, and separation of adherences using a video--laparoseope in 2~ 3 days after the recanalization. And oviduct forming or neostomy were performed in some patients when necessary. The recanalization rate, alliance recanalization rate, pregnancy rate, and the rate of ectopic pregnancy or repeated oviduct obstruction were analyzed statistically. Results The therapeutic processes of oviduct recanalization and video--lapa- roscope were performed successfully in all cases including 127 oviducts. Of them,124 of 127 oviducts （97.6%） were simple recanali- zation, the rate of recanalization treated with combined method was 96.0% （122 of 127）. There were postoperative pregnancy in one year in 39 of 67 patients （58.2% ）, and ectopic pregnancy in 3 of 67 patients （4.5 % ）. 28 patients had not postoperative pregnancy in one year,of them, 27 patients underwent repeated salpingography and the oviducts were unobstructed in 10 patients,17/67 oviducts were repeated obstructed （25.4% } including adherences complicated with hydrops in fimbriated extremity of fallopian in 13 of 67 （ 19.4%） and repeated obstruction in other segments in 4 of 67 （6.0%）. In the other one patient without postoperative pregnancy in one year, the treatment was terminated owing to tuberculosis in genital duct. Conclusion The treatment of infertilitas feminis caused by salpingemphraxis by oviduct recanalization in combination with video--laparoscope is of significant clinical value.

关 键 词：不孕症 输卵管阻塞 输卵管再通术 电视腹腔镜 

分 类 号：R711.6[医药卫生—妇产科学] R711.76[医药卫生—临床医学]