子宫输卵管造影显示输卵管近端阻塞行宫腹腔镜联合手术118例结果分析  

Laparoscopic Findings of 118 Patients with Proximal Tubal Occlusion by Hysterosalpingography

作　　者：郑兴邦[1] 关菁[1] 于晓明[1] 韩红敬[1] 沈浣[1] 

机构地区：[1]北京大学人民医院,北京100044

出　　处：《实用妇产科杂志》2015年第3期213-216,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨子宫输卵管造影(HSG)提示的输卵管近端阻塞患者的盆腔病变特征。方法:选择2011年5月至2013年5月行HSG提示输卵管近端阻塞性不孕并行宫腹腔镜联合手术(腹腔镜下输卵管通液术及宫腔镜下输卵管插管术)患者118例,根据术后结果分为假阳性组(50例)、插管通畅组(50例)和插管失败组(18例),比较3组间合并盆腔子宫内膜异位症(内异症)、盆腔非内异症炎性粘连及输卵管远端微小病变的比例。结果:HSG诊断近端阻塞假阳性率为42.4%(50/118)。假阳性组及插管通畅组合并盆腔内异症的比例(68.0%,52.0%)明显高于插管失败组(5.6%);合并输卵管远端微小病变的比例(30.0%,14.0%)明显高于插管失败组(0);而合并盆腔非内异症炎性粘连的比例(18.0%,28.0%)则明显低于插管失败组(66.7%),差异均有统计学意义(P<0.01)。结论:HSG提示输卵管近端阻塞但为假阳性时,可能为暂时性管腔阻塞,多合并盆腔内异症,内异症微小病变可能是导致输卵管各部位功能障碍的原因;而输卵管近端真性阻塞为永久性管腔闭锁,多合并盆腔的慢性炎症。Objective ：To evaluate the laparoscopic findings of patients with proximal tubal occlusion by hyste- rosalpingography（HSG）. Methods： Retrospective analysis of 118 patients with proximal tubal occlusion who un- derwent hysteroscopy and laparoscopy in Peking University People＇s Hospital from 2011.5 to 2013.5. If proximal tubal occlusion was confirmed by laparoscopy,then the hysteroscopic tubal catheterization was performed. Based on the surgery results,the patients were divided into three groups：false positive group, successfully cannulated group and unsuccessfully cannulated group. The incidences of endometriosis and pelvic inflammatory adhesion were compared among three groups. Results.The false positive rate of HSG for proximal tubal blockage was 42.4%（50/118）. The incidence of endometriosis in false positive group and successfully cannulated group （68, 0% and 52.0%） was significantly higher than that in unsuccessfully cannulated group （5.6%）. The inci- dence of tiny lesion in distal tube in false positive group and successfully cannulated group（30.0% and 14.0% ） was significantly higher than that in unsuccessfully cannulated group （0）. The pelvic inflammatory adhesion inci- dence in the unsuccessfully cannulated group （66. 7%） was significantly higher than that in other two groups （18.0% and 28. 0% ） （ P〈0. 01 ）. Conclusions-The proximal tubal occlusion diagnosed by hysterosalpingogra- phy can be divided into transient and permanent occlusion. The transient occlusion might be reversible,caused by tubal spasm or endometriosis. The permanent occlusion was usually related to pelvic inflammatory disease and salpingitis isthmica nodosa（SIN）.

关 键 词：输卵管近端阻塞 子宫内膜异位症 子宫输卵管造影 

分 类 号：R711.76[医药卫生—妇产科学]