经阴道注水腹腔镜联合宫腔镜对输卵管妊娠治疗后输卵管功能及盆腔状态的评价  

The evaluation of the function of tube and pelvic conditions under transvaginalhydrolaparoscopy combined with hysteroscopy for tubal pregnancy

作　　者：赵辉[1] 杨保军[1] 冯力民[1] 

机构地区：[1]首都医科大学附属北京天坛医院妇产科,北京100050

出　　处：《中国内镜杂志》2014年第8期800-804,共5页China Journal of Endoscopy

摘　　要：目的 探讨经阴道注水腹腔镜联合宫腔镜对输卵管妊娠治疗后输卵管功能及盆腔状态的评定价值。寻找评价输卵管妊娠治疗后生殖状态的简单、安全及准确的方法。方法 选取2010年6月-2011年12月,在该院妇科诊治成功的输卵管妊娠患者,有生育要求者18例,治疗后3～12个月,行经阴道注水腹腔镜联合宫腔镜检查,评定患者的输卵管功能及盆腔状态,指导患者正常受孕。结果 18例THL者中,有16例1次穿刺成功,穿刺成功率为88.88%。4例患侧输卵管切除术,对侧输卵管完全通畅率为25%,14例输卵管妊娠保守治疗,双侧输卵管完全通畅率28.6%,单侧完全通畅率35.7%;发现盆腔子宫内膜异位症2例（11.1%）,盆腔粘连8例（44.4%）,输卵管周围粘连5例（27.8%）,卵巢粘连4例（22.2%）,输卵管系膜囊肿1例（5.6%）,子宫内膜息肉2例（11.1%）,子宫内膜炎2例（11.1%）,宫腔粘连1例（5.6%）。18例患者随访5～21个月,平均（13.7±4.6）个月,失访3例,自然妊娠6例（33.3%）,重复宫外孕1例（5.6%）。结论 经阴道注水腹腔镜联合宫腔镜对输卵管妊娠治疗后输卵管功能及盆腔状态的评定直观、准确、安全及微创,对患者获得正常宫内妊娠有指导作用。[Objective ] To explore the value of transvaginalhydrolaparoscopy combined with hysteroscopy in the assessment of the function of tube and pelvic conditions after treatment of tubal pregnancy. To seek a simple, safe and accurate method to evaluate reproductive status after treatment of tubal pregnancy. [ Methods ] 18 women with tubal pregnancy who were treated successfully and desired childbearing from June 2010 to December 2011 were selected. They received transvaginalhydrolaparoscopy combined with hysteroscopy at 3-12 months after treatment, the function of fallopian tube and pelvic conditions of the cases were observed in order to guide them to obtain normal intrauterine pregnancy. [Results] Among 18 cases, 16 cases were successful in the first puncture, the success rate was 88.88%. of 4 cases of salpingectomy, unilateral complete tubal patency rate was 25%; of 14 cases of conservative treatment, bilateral tubal latency rate was 28.6% and unilateral tubal patency rate was 35.7%. 2 cases were found with endometriosis （11.1%）; 8 cases were found with pelvic adhesion （44.4%）; 5 cases were found with adhesion of fallopian tubes （27.8%）; 4 cases were found with adhesion of ovaries （22.2%）; 1 case was found with mesos- alpinx cyst （5.6%）; 2 cases were found with endometrial polyp （11.1%）; 2 cases were found with endometritis （11.1%）; 1 case was found with intrauterine adhesion （5.6%）. 18 cases were followed up for 5-21 months （mean, 13.7±4.6 months）, 3 cases were lost, 6 cases obtained normal intrauterine pregnancy （33.3%%） and 1 case showed recurrent ectopic pregnancy （5.6%）. [ Conclusion ] Transvaginalhydrolaparoscopy combined with hysteroscopy is a direct, accurate, safe and minimally invasive procedure for evaluating the function of tube and pelvic conditions after treatment of tubal pregnancy. It may be taken as a guide in obtaining normal intrauterine pregnancy.

关 键 词：输卵管妊娠 甲氨蝶呤 米非司酮 宫腔镜 经阴道注水腹腔镜 生殖状况 

分 类 号：R713.5[医药卫生—妇产科学]