输卵管性不孕患者盆腔粘连相关因素分析  

Analysis of related factors in tubal factor infertile patients with pelvic adhesion

作　　者：李海宁[1] 丁永慧[1] 陈华[1] 马洁[1] 

机构地区：[1]宁夏医科大学总医院妇科,宁夏银川750004

出　　处：《宁夏医学杂志》2015年第9期827-830,共4页Ningxia Medical Journal

基　　金：宁夏自然科学基金资助项目(NZB173)

摘　　要：目的探讨输卵管性不孕症患者盆腔粘连产生的相关因素。方法收集因输卵管性不孕且接受腹腔镜检查的239例患者的临床资料,根据术中检查盆腔粘连程度、范围、输卵管伞端粘连及闭锁情况,分为盆腔粘连组159例,依据粘连程度分为I～Ⅳ度,其中I度52例,Ⅱ度48例,Ⅲ度55例,Ⅳ度4例;无盆腔粘连患者作为对照组共80例。分析盆腔粘连的相关因素与既往病史、盆腹腔病变及输卵管功能的关系。结果相关因素：盆腔粘连组不孕时间〈2年（51.6%）及〉5年（16.8%）的比例高于对照组（分别为28.8%、13.8%）;盆腔粘连组药物流产史（12.3%）、盆腔炎性疾病史（56.1%）、盆腔及邻近器官手术史（20.6%）、宫腔操作史（35.5%）的发生率均高于对照组（分别为10.0%、40.0%、6.3%、22.5%）;多因素分析,患者职业（OR=2.792,95%CI为1.358～5.738）、人工流产史（OR=0.450,95%CI为0.264～0.767）、不孕时间（OR=1.174,95%CI为1.010～1.364）、既往有PID史（OR=14.891,95%CI为1.23～1.39）、盆腔及邻近器官手术史（OR=0.145,95%CI为1.80～1.89）及HSG次数（OR=0.453,95%CI为0.307～0.669）为盆腔粘连发生的主要影响因素。结论患者的职业、人工流产史、不孕时间、既往有盆腔炎性疾病史、盆腔及邻近器官手术史及HSG次数是造成输卵管性不孕症患者盆腔粘连发生的高危因素。Objective To investigate factors with pelvic adhesions in tubal factor infertility patients. Methods Total of 239 tubal factor infertile patients undergoing laparoscopy were retrospectively studied. According to the extent of pelvic adhesions,tubal umbrella adhesions and atresia,159 cases were classified into adhesion groups,including 52 cases in grade I,48 cases in grade II,55 cases in grade III and 4 cases in grade IV based on adhesion score. The 80 cases with no obvious pelvic adhesion were matched as control group. The relationship between pelvic adhesions and related history,abdominal lesions,tubal patency and the prognosis were studied.Results Related factors： the frequency of pelvic adhesion and less than 2 years（51. 6%） and more than 5 years（16. 8%） of infertility in adhesion group（28. 8%） were significantly higher than in control groups（13. 8%）. History： compared with the control group（10. 0%,40. 0%,6. 3% and 22. 5%）,patients with pelvic adhesions present more incidence medical abortion（12. 3%）,pelvic inflammatory disease（56. 1%）,pelvic and adjacent organs surgery（20. 6%）,uterine cavity operation（35. 5%）. Multivariate analysis： It was found that the patient＇s occupation（OR = 2. 792,95% CI 1. 358 ～ 5. 738）,surgical abortion history（OR = 0. 450,95% CI 0. 264 ～0. 767）,infertile time（OR = 0. 450,95% CI 1. 010 ～ 1. 364）,pelvic inflammatory disease history（OR = 14. 891,95% CI 1. 23 ～1. 39）,pelvic and adjacent organs surgery history（OR = 0. 145,95% CI 1. 80 ～ 1. 89） and the numbers of HSG（OR = 0. 453,95% CI0. 307 ～ 0. 669） were risk factors with pelvic adhesions of tubal factor infertile patients. Conclusion The patient＇s occupation,surgical abortion history,infertile time,pelvic inflammatory disease history,pelvic and adjacent organs surgery history and the numbers of HSG are important factors for pelvic adhesions of tubal factor infertile patients.

关 键 词：粘连 不孕 腹腔镜 相关因素 

分 类 号：R711.6[医药卫生—妇产科学]