宫腹腔镜下输卵管阻塞性不孕症患者输卵管形态变化与术后妊娠结局的关系  

Relationship between tubal morphological changes and postoperative pregnancy outcome in patients with tubal obstructive infertility under hysteroscopy

作　　者：杨瑞娟 李玉萍 刘琴 YANG Ruijuan;LI Yuping;LIU Qin(Department of Gynecology,the 73rd Army Hospital of the Army,Xiamen,Fujian 361000,China)

机构地区：[1]陆军第七十三集团军医院妇科病区,福建厦门361000

出　　处：《中国优生与遗传杂志》2023年第3期539-547,共9页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨宫腹腔镜下输卵管阻塞性不孕症患者输卵管形态变化与术后妊娠结局的关系。方法选取2019年1月至2021年1月于陆军第七十三集团军医院行宫腹腔镜治疗的161例输卵管阻塞性不孕症患者纳入建模组,根据术后18个月内妊娠结果分为自然妊娠组(84例)和未自然妊娠组(77例)。比较两组一般资料,多因素Logistic回归分析术后妊娠结局的危险因素,R软件构建贝叶斯网络模型,Netica软件进行模型推理预测。同期选取不同研究机构的50例患者作为外部数据集,受试者操作特征(ROC)曲线和校准曲线评价模型。结果术后总自然受孕率为52.17%,自然妊娠组患者年龄、不孕病程、月经周期延后、痛经、输卵管妊娠史、人流次数、盆腔炎病史、盆腔粘连程度、输卵管不畅通、输卵管迂曲、输卵管僵直、输卵管似串珠样改变比例、术后白介素-2(IL-2)、白介素-10(IL-10)、肿瘤坏死因子(TNF-α)水平低于未自然妊娠组(P<0.05)。多因素Logistic回归分析显示:年龄、输卵管妊娠史、盆腔粘连程度与输卵管形态存在关联。输卵管妊娠史、单侧/双侧输卵管不畅通、迂曲、僵直、似串珠样改变、盆腔炎病史、盆腔粘连程度、术后IL-2、IL-10、TNF-α水平是术后未自然妊娠的独立危险因素(P<0.05)。贝叶斯网络结构模型显示,输卵管迂曲、僵直、似串珠样改变、盆腔粘连程度与患者妊娠结局不良存在直接联系。ROC曲线和校准曲线显示贝叶斯网络模型具有良好的区分度和准确度。结论盆腔炎病史、盆腔粘连程度、高水平IL-2、IL-10、TNF-α、输卵管妊娠史、输卵管的形态改变是无法自然妊娠的危险因素,其中盆腔炎病史、盆腔粘连程度、输卵管形态与妊娠结局存在直接联系。Objective To investigate the relationship between tubal morphological changes and postoperative pregnancy outcome in patients with tubal obstructive infertility under hysteroscopy.Methods 161 patients with tubal obstructive infertility who underwent laparoscopic surgery in the 73rd Army Hospital of the Army from January 2019 to January 2021 were selected into the model group.according to the results of 18 months follow-up pregnancy,they were divided into natural pregnancy group(n=84)and unnatural pregnancy group(n=77).The general data of the two groups were compared,the risk factors affecting the postoperative pregnancy outcome were analyzed by Logistic regression,the Bayesian network model was constructed by R software,and the Bayesian network model was inferred and predicted by Netica software,and the differentiation and accuracy of the model were evaluated by receiver operating characteristics(ROC)curve and calibration curve.In the same period,50 patients with tubal obstructive infertility from different research institutions were used as external data sets to verify the differentiation and accuracy of the model.Results The total natural pregnancy rate after operation was 52.17%.The age,course of infertility,delayed menstrual cycle,dysmenorrhea,history of tubal pregnancy,artificial abortion,history of pelvic inflammation,degree of pelvic adhesion,obstruction of fallopian tube,tortuosity of fallopian tube,rigidity of fallopian tube,beaded changes of fallopian tube,postoperative levels of interleukin-2(IL-2),interleukin-10(IL-10)and tumor necrosis factor(TNF-α)in the natural pregnancy group were significantly lower than those in the unnatural pregnancy group(P<0.05).Multivariate Logistic regression analysis showed that age,history of tubal pregnancy and degree of pelvic adhesion were associated with tubal morphology.History of tubal pregnancy,unilateral/bilateral tubal obstruction,tortuosity,rigidity,beaded changes,History of pelvic inflammation,degree of pelvic adhesion and postoperative levels of IL-2,IL-10 a

关 键 词：宫腹腔镜 输卵管阻塞性不孕症 贝叶斯网络模型 妊娠结局 

分 类 号：R713.7[医药卫生—妇产科学]