输卵管妊娠患者输卵管开窗取胚术及切除术后继发不孕原因及输卵管损伤比较研究  

Analysis of tubal abnormality in infertility women with past history of tubal pregnancy after salpingostomy and salpingectomy

作　　者：胡春秀[1] 侯海燕[1] 高秀霞[1] 张岩[1] 曹振兰 陈雪莲[1] 陈亚琼[1] 

机构地区：[1]武警后勤学院附属医院妇产科,天津300162

出　　处：《中国实用妇科与产科杂志》2015年第12期1133-1136,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨输卵管妊娠患者经输卵管开窗取胚术和切除术后继发不孕的原因及输卵管受损情况。方法收集2008年12月至2010年10月在武警后勤学院附属医院住院治疗,既往有输卵管妊娠、经输卵管开窗取胚术或切除术病史的不孕患者130例。根据既往输卵管妊娠手术方式分为开窗取胚组(37例)和切除组(93例)。采用腹腔镜观察盆腔粘连程度、输卵管形态、输卵管伞端等情况;并在腹腔镜监护下行宫腔镜下输卵管口插管通液,观察输卵管管腔是否通畅。结果 94.62%患者存在输卵管性不孕因素,包括宫腔及输卵管形态异常或周围粘连、伞端闭锁、管腔堵塞,至少有1个或多个因素合并存在;盆腔粘连发生率91.54%。两组患者无妊娠史的输卵管形态异常在开窗取胚组发生率为62.16%,在切除组为48.39%;伞端闭锁或积水在开窗取胚组为62.16%,在切除术组为44.09%;管腔堵塞在开窗取胚组为81.08%,在切除术组为82.80%,两组间差异均无统计学意义(P>0.05)。盆腔粘连程度方面,Ⅰ、Ⅱ、Ⅲ度粘连发生率在开窗取胚组分别为21.62%、32.43%、35.14%,在切除组分别为29.03%、27.96%、33.33%,两组在粘连发生率、发生程度上差异均无统计学意义(P>0.05)。开窗取胚组有妊娠史和无妊娠史的输卵管形态异常发生率分别为48.65%和62.16%,伞端闭锁或积水发生率为45.95%和62.16%,管腔通畅发生率为24.32%和18.92%,差异无统计学意义(P>0.05)。结论输卵管妊娠开窗取胚术后的不孕患者,不孕的主要原因为输卵管因素和盆腔粘连,包括输卵管形态异常及周围粘连和伞端异常、管腔堵塞。输卵管开窗取胚术和切除术对无妊娠史的输卵管形态、伞端异常和管腔通畅度影响无明显区别。在开窗取胚术后不孕患者中,保留的患侧输卵管与无妊娠史的输卵管受损无明显差异。Objective To study the tubal abnormality in infertility women of past history with tubal pregnancy after salpin- gostomy and salpingectomy.Methods Laparoseopy was performed to observe pelvic adhesions, tube shape, fimbriated extremity of fallopian and other infertility factors, and hysteroscopic tubal catheterization and hydrotubation was used to diagnose tubal patency and evaluate the intrauterine cavity of 130 impatients who had history of tubal pregnancy and re- ceived salpingostomy or salpingectomy.These patients were divided into the group of salpingostomy and salpingectomy ac- cording to the operation method in the past, during December 2008 and October 2010, at Obstetrics ＆ Gynecology De- partment, the Affiliated Hospital of the Chinese People＇s Armed Police Force Logistics College.Results About 94.62% of the patients were found to have tube infertility caused by tube abnormality and adhesions, or tube obstruction, which might appear alone or concurrently.Pelvic adhesion occurrence reached 91.54%.In the tubes without pregnancy history,tube abnormality in the groups of salpingostomy and sal- pingectomy accounted for 62.16% vs. 48.39%, fimrial occlusion of fallopian tube 62.16% vs. 44.09%, tube paten- cy 18.92% vs. 17.20%, respectively, and no statistically significant difference was found between two groups.Plevic adhesion accounted for 32.43% （ Ⅰ degree）, 29.03% （Ⅱ de- gree）, and 35.14%（ Ⅲ degree） in the group of salpingostomy,and 29.03%（ Ⅰ degree）, 27.96%（ Ⅱ degree）, 33.33%（ Ⅲ de- gree） in the group of salpingeetomy.No statistically significant difference was found between two groups.Tube abnormality, fimrical occlusion of fallopian tube and tube patency in tubes of with or without pregnancy history in the groups of salpingostomy was 48.65% vs.62.16%, 45.95% vs.62.16%, and 24.32% vs.18.92%, which had no statistically significant difference between them （P 〉 0.05）. Conclusion Infertility of women who have had tubal pregnancy and received salpin- gostomy or salp

关 键 词：不孕 输卵管妊娠 输卵管开窗取胚术 输卵管切除术 腹腔镜检查术 宫腔镜检查术 

分 类 号：R714.221[医药卫生—妇产科学]