宫腹腔镜经输卵管插管疏通治疗输卵管阻塞症  

Treatment of oviduct obstruction with transcervical tubal intubation and recanalization under laparoscopy and hysteroscopy

作　　者：黄晔[1] 刘越[1] 胡强[1] 

机构地区：[1]福建省立医院妇产科,福建福州350001

出　　处：《中国妇幼健康研究》2009年第6期680-682,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨宫腹腔镜联合经宫颈输卵管插管再通术治疗输卵管近中段阻塞的效果及可能的影响因素。方法选择在腹腔镜下行输卵管通液后证实输卵管近中段阻塞的患者136例，行经宫腹腔镜联合输卵管插管再通术。结果136例患者224条输卵管近中段阻塞。输卵管外周有粘连的186条，输卵管外观正常仅管腔阻塞的38条。术后再通154条，再通率为68．75％。64条有宫角粘连的输卵管插管失败52条（52／64，81．25％），较无宫角粘连者的输卵管插管失败率（18／38，47．36％）明显高（χ^2=50．9760，P〈0．01）。随访：经双侧插管再通成功76例，宫内妊娠28例，宫内妊娠率36．84％，插管侧输卵管妊娠7例，输卵管妊娠率为9．21％，宫内妊娠率明显高于输卵管妊娠率（u=25．1818，P〈0．,01）。导管组妊娠率明显高于导丝组（χ^2=16．6288，P〈0．01），两者的输卵管妊娠率无显著性差异（P〉0．05）。结论宫腹腔镜联合输卵管插管再通术对输卵管近中段阻塞有较好治疗效果，影响再通和术后妊娠率的因素主要是输卵管阻塞程度和有无宫角粘连。Objective To investigate effect of transcervical tubal intubation and recanalization by laparoscopy combined with hysteroscopy for oviduct obstruction in proximal and middle portion and possible influencing factors. Methods 136 cases of oviduct obstruction in proximal and middle portion diagnozed by hydrotubation under laparoscopy were selected, transcervical tubal intubation and recanalization were performed by means of laparoscopy combined with hysteroscopy. Results 224 obstructive oviducts in proximal and middle portion of 136 patients were found. Of which, 186 cases of obstructive oviducts presented superficial adhesion of the tube and 38 cases of them presented only lumenal obstruction with normal appearance. 154 oviducts were successfully recanalized after operation, and recanalization rate was 68.75%. 52 of 64 oviducts with cornual adhesion failed to be recanalized （81.25%） and the failure rate of intubation and recanalization was significantly higher than that of oviducts without cornual adhesion （ 18/38,47.36% ） （χ^2 = 50. 9760, P 〈 0.01 ）. By follow up, 76 cases succeded in bilateral tubal incubation and recanalization, and 28 intrauterine pregnancies were found and the intrauterine pregnancy rate was 36.84%. 7 cases of tubal pregnancy occurred in intubated oviduct, and incidence of tubal pregnancy was 9.21%. The intrauterine pregnancy rate was significantly higher than tubal pregnancy rate （ u = 25. 1818, P 〈 0.01 ）. The intrauterine pregnancy rate in the catheter group was significantly higher than that in the guide wire group（χ^2= 16. 6288 ,P 〈 0.01 ）, while in tubal pregnancy rate there was no significant difference （ P 〉 0.05 ）. Conclusion The therapeutic effect of laparoscopic and hysteroseopic transcervical tubal incubation and recanalization is significant for oviductive obstruction in proximal and middle portion. The major factors influencing recanalization rate and postoperative pregnancy rate mainly include degree of oviduct obstruction and presence or absenc

关 键 词：输卵管阻塞 输卵管插管和复通 宫腔镜 腹腔镜 

分 类 号：R711.76[医药卫生—妇产科学]