宫腹腔镜联合诊治女性不孕症461例临床疗效分析  

Clinical analysis of hysteroscopy combined with laparoscopy in the diagnosis and treatment of 461 infertility women

作　　者：乌云塔娜[1] 刘玲玲[2] 赵勇[2] 王蔼明[2] 

机构地区：[1]内蒙古民族大学临床医学院,通辽028000 [2]中国人民解放军海军总医院生殖中心

出　　处：《中国计划生育学杂志》2016年第4期256-260,共5页Chinese Journal of Family Planning

摘　　要：目的：探讨宫腹腔镜联合手术在女性不孕症诊断治疗价值以及术后妊娠结局的相关因素。方法：回顾性分析2008年1月~2014年5月因不孕症在海军总医院行宫腹腔镜联合检查和手术治疗的患者461例,宫腹腔镜下评估不孕症病因、术后电话随访妊娠情况、妊娠结局,比较原发性不孕症和继发性不孕症的妊娠率,观察年龄和盆腔粘连程度对妊娠结局的影响。结果：461例不孕症患者中,原发性不孕225例（48.8%）,继发性不孕236例（51.2%）。不孕症的主要原因是盆腔粘连54.5%（251例）、输卵管阻塞50.8%（234例）、子宫内膜异位症157例（34.1%）。盆腔粘连、输卵管阻塞和宫腔粘连发生率继发生不孕症高于原发性不孕症,生殖器结核仅发生于原发性不孕者,其他不孕因素两者之间没有统计学差异。术后随访率为85.25%。术后自然妊娠50.6%,原发性不孕患者的妊娠率为49.5%,继发性不孕患者的妊娠率为51.8%,妊娠时间主要集中在术后1年内,足月分娩43.8%。20-30岁年龄组的妊娠率（54.9%）高于31-43岁组（45.5%）（P〈0.05）。无盆腔粘连、轻、中度粘连者和重度粘连者的妊娠率分别为61.5%、54.8%、40.6%和18.9%,无盆腔粘连者妊娠率和足月分娩率明显高于盆腔粘连者（P〈0.05）;盆腔粘连组中轻、中度粘连者妊娠率和足月分娩率与重度粘连者比较,差异有统计学意义（P〈0.05）,轻度和中度粘连间比较无统计学差异（P〉0.05）。结论：宫腹腔镜联合手术能更加直观的评估不孕症病因,同时可针对病因进行相应治疗,手术时间短、创伤小,能提高不孕患者的临床妊娠率和足月分娩率,对女性不孕症的诊断与治疗有重要临床价值。Objective：To explore the value of hysteroscopy combined with laparoscopy for diagnosis and treatment of infertility women,and to study the relation factors on pregnancy outcomes of women after surgery.Methods：A retrospective study was conducted based on data of 461 infertility women from January,2008 to May,2014 at Navy General Hospital,who were all diagnosed and treated by hysteroscopy combined with laparoscopy.The data about pregnancy and pregnant outcomes of these women after surgery were collected by telephone.Pregnancy rates of women with primary infertility or secondary infertility were compared.And influence of age or pelvic adhesion on pregnancy outcome was also analyzed.Results：Among 461 women,there were 225（48.8%）cases with primary infertility and 236cases（51.2%）with secondary infertility.The main reasons of infertility included pelvic adhesions（251cases,54.5%）,fallopian tube obstruction（234cases,50.8%）,and endometriosis（157cases,34.1%）.The rate of pelvic adhesions,fallopian tube obstruction and intrauterine adhesion of women with secondary infertility were higher than those of women with primary infertility.Genital tuberculosis only occurred in women with primary infertility（P〈0.05）.Other infertility reasons had no significant difference between women with primary infertility and women with secondary infertility.The total rate of follow-up after surgical was 85.25%.Rate of spontaneous conception after surgery was 50.6%,rate of pregnancy in women with primary infertility was 49.5%,and that in women with secondary infertility was 51.8%.Rate of term delivery was 43.8%.Pregnancy mainly occurred within 1year after surgery.Pregnancy rate of women in20 to 30years old women was 54.9%,which was significant higher than that of women in 31 to 43years old（45.5%）（P〈0.05）.Pregnancy rates of women with non pelvic adhesions,mild pelvic adhesions,moderate adhesions or severe adhesions was 61.5%、54.8%、40.6% and 18.9%,respectively.Both rate of pregnancy and term delivery of w

关 键 词：宫腹腔镜联合检查 不孕症 妊娠率 足月分娩率 

分 类 号：R711.6[医药卫生—妇产科学]