不孕症腹腔镜联合宫腔镜检查的临床价值  

Clinical significance of laparoscopy combined with hysteroscopy in infertile patients

作　　者：陈蓉[1] 田秦杰[1] 陈蔚林[1] 刘长欣[1] 朱爱珍[1] 温秀艳[1] 周远征[1] 孙爱军[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2010年第6期449-451,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的了解不孕症患者行腹腔镜检查同时作宫腔镜的临床意义。方法对2004年8月至2005年4月因不孕症在我院行腹腔镜和宫腔镜联合检查的患者进行回顾性分析。共232例患者入选。按术前超声和造影检查的结果分为术前宫腔正常组144例、异常组41例,术前未作宫腔检查组47例。将宫腔镜检查术中发现结合病理结果,与术前的超声和子宫输卵管造影(HSG)的结果作对比。结果患者年龄(32.4±3.8)岁(23～43岁)。其中原发不孕症113例(48.7%),继发不孕症119例(51.3%)。不孕症年限(4.9±3.0)年(1～18年)。术前宫腔正常组144例中,宫腔镜诊断宫腔异常21例(14.6%);术前宫腔异常组41例中,宫腔镜诊断宫腔异常17例(41.5%);术前未作检查组47例中,宫腔镜诊断宫腔异常16例(34.0%)。三组之间宫腔异常率差异有统计学意义(P<0.01)。以宫腔镜作为金标准,超声诊断宫腔内病变的灵敏度40.0%,特异度81.4%,阳性预测值36.4%,阴性预测值83.6%;HSG诊断宫腔内病变的灵敏度30.0%,特异度90.8%,阳性预测值50.0%,阴性预测值80.8%。提示在不明显增加患者经济负担的前提下,辅助的宫腔镜检查对于发现和治疗宫腔异常具有超声和造影不可替代的作用。结论在腹腔镜手术同时行宫腔镜检查有助于发现和治疗不孕症的原因。Objective To explore the clinical significance of laparoscopy combined with hysteroscopy in patients with infertility. Methods Two hundreds and thirty-two infertile patients who underwent laparoseopy combined with hysteroscopy in our hospital between August 2004 and April 2005 were recruited. Based on the results of pre-operation ultrasound scan and hysterosalpingography （HSG）, all patients were assigned into three groups： normal uterus cavity group （144 patients ）, abnormal uterus cavity group （41 patients） and neither examination group （47 patients ）. The results of pre-operation ultrasound scan and HSG were compared with the findings in hysteroseopy and of pathology. Results The average age was （32.4 ＋ 3.8 ） years（ 23 - 43 years old）. One hundred and thirteen patients （48.7%） were with primary infertility and 119 patients（51.3% ）with secondary infertility. The average infertile duration was （4.9-3.0） years （ 1 - 18 years）. In normal uterus cavity group, 21 patients had abnormal diagnosis （ 14.6% ）. The rates of abnormal diagnosis in normal uterus cavity group, abnormal uterus cavity group and neither examination group were 14.6%, 41.5% and 34. 0% , respectively. The difference among groups was significant （ P 〈 0.01 ）. For the B ultrasound scan and HSG, the sensitivity, specificity, positive expectation and negative expectation on uterus cavity abnormality with hysteroscopy diagnosis as golden standard, were 40.0%, 30.0% ; 81.4% , 90.8% ; 36.4% , 50.0% ; 83.6%, 80.8%, respectively. It suggested adjuvant hysteroscopy had great advantages on finding and treating the cavity abnormality, compared with the B ultrasound scan and HSG, while didn＇t cost much more. Conclusions Laparoscopy combined with hysteroscopy substantially does favor to find and treat the reasons of infertility.

关 键 词：宫腔镜 腹腔镜 不孕症 

分 类 号：R71[医药卫生—妇产科学]