经阴道注水腹腔镜与宫腔镜联合诊治不孕症的临床疗效及对机体应激反应的影响  

Clinical Effect of Transvaginal Hydrolaparoscopy Combined with Hysteros⁃copy in the Diagnosis and Treatment of Infertility and Its Impact on the Stress Response of the Body

作　　者：韩慈 胡晓丽 甄银芝 叶晶 扈学艳 张欣 张钰 HAN Ci;HU Xiaoli;ZHEN Yinzhi;YE Jing;HU Xueyan;ZHANG Xin;ZHANG Yu(NCO School of PLA Army Military Medical University,Shijiazhuang 050011,China;Department of Obstetrics and Gynecology,the Affiliated Hospital of NCO School of PLA Army Military Medical University,Shijiazhuang 050000,China)

机构地区：[1]中国人民解放军陆军军医大学士官学校,石家庄050011 [2]中国人民解放军陆军军医大学士官学校附属医院妇产科,石家庄050000

出　　处：《临床误诊误治》2025年第7期55-61,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委员会项目(20211370)。

摘　　要：目的探究经阴道注水腹腔镜(THL)与宫腔镜联合诊治不孕症的临床疗效及对机体应激反应的影响。方法选取2021年7月至2023年1月就诊的322例女性不孕症为观察对象。依据检查方式不同分为联合组及造影组,每组161例。联合组予以THL与宫腔镜联合手术,造影组予以子宫输卵管碘油造影。记录并比较2种不同检查诊断输卵管通畅程度的一致性、盆腔异常情况以及随访1年内妊娠情况,比较2组疼痛程度[疼痛视觉模拟评分法(VAS)、Wong⁃Baker脸谱评分]、手术前后应激反应指标[促肾上腺皮质激素(ACTH)、去甲肾上腺素(NA)、血管紧张素Ⅱ(AⅡ)、皮质醇(Cor)]及并发症发生率。结果联合组诊断输卵管双侧通畅比例高于造影组,双侧不通畅比例低于造影组(P<0.05)。经Kappa检验,不同检查诊断输卵管通畅程度的一致性评价差异有统计学意义(P<0.01)。联合组诊断盆腔异常总阳性率为83.23%(134/161),高于造影组的44.10%(71/161,P<0.05)。随访1年内联合组自然宫内妊娠率高于造影组,未妊娠率低于造影组(P<0.05)。2组辅助生殖妊娠率、流产率及异位妊娠率比较无统计学意义(P>0.05)。2组手术后与手术前比较,ACTH、NA、AⅡ、Cor水平均升高,且联合组手术后ACTH和Cor水平低于造影组(P<0.05)。联合组术中Wong⁃Baker脸谱评分及术后VAS评分均低于造影组(P<0.05)。联合组并发症发生率为8.07%(13/161)低于造影组的27.33(44/161,P<0.05)。结论THL与宫腔镜联合在不孕症临床诊治中既可直接观察盆腔及宫腔异常、准确判断输卵管情况,也可治疗子宫内膜息肉、宫腔粘连、盆腔粘连等病变,且安全性高、应激反应轻,从而缩短女性不孕症患者诊断与治疗周期。Objective To explore the clinical effect of transvaginal hydrolaparoscopy(THL)combined with hysteros⁃copy in the diagnosis and treatment of infertility and its impact on the stress response of the body.Methods A total of 322 female infertile patients treated from July 2021 to January 2023 were selected as the observation subjects.According to differ⁃ent examination methods,they were divided into the combination group and the angiography group,with 161 patients in each group.The combination group was treated with THL combined with hysteroscopy,and the angiography group was treated with hysterosalpingography.The consistency of two examination methods in the diagnosis of fallopian tube patency,pelvic abnor⁃malities and pregnancy within 1 year of follow⁃up were recorded and compared.The severity of pain[visual analogue scale(VAS),Wong⁃Baker FACES pain rating scale score],stress response indexes[adrenocorticotropic hormone(ACTH),nora⁃drenalin(NA),angiotensinⅡ(AⅡ),cortisol(Cor)],and the incidence of complications were compared between the two groups.Results The proportion of bilateral patency of fallopian tubes in the combination group was higher than that in the angiography group,and the proportion of bilateral obstruction was lower than that in the angiography group(P<0.05).The Kappa test showed that there was a significant difference in the consistency evaluation of different examinations in the diagnosis of tubal patency(P<0.01).The total positive rate of the examination of pelvic abnormalities in the combination group was 83.23%(134/161),which was higher than 44.10%(71/161)in the angiography group(P<0.05).Within 1 year of fol⁃low⁃up,the natural intrauterine pregnancy rate of the combination group was higher than that of the angiography group,and the non⁃pregnancy rate was lower than that of the angiography group(P<0.05).There were no significant differences in the as⁃sisted reproductive pregnancy rate,abortion rate and ectopic pregnancy rate between the two groups(P>0.05).The levels of ACTH

关 键 词：不孕症 经阴道注水腹腔镜 宫腔镜 子宫输卵管碘油造影 诊断 妊娠 应激反应 皮质醇 

分 类 号：R711.6[医药卫生—妇产科学]