盆腔粘连松解术及输卵管伞端造口术治疗盆腔炎致不孕症的效果  

Effect of pelvic adhesion-lysis and tubal fimbriostomy in the treatment of infertility caused by pelvic inflammatory disease

作　　者：钱丽 王梅 肖燕 QIAN Li;WANG Mei;XIAO Yan(Department of Gynecology,Panzhihua Maternal and Child Health Hospital,Panzhihua Sichuan 617000,China)

机构地区：[1]攀枝花市妇幼保健院妇科,四川攀枝花617000

出　　处：《临床和实验医学杂志》2025年第6期636-640,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省医学青年创新科研课题计划(编号:Q20011)。

摘　　要：目的探讨盆腔粘连松解术及输卵管伞端造口术治疗因盆腔炎导致的不孕症的临床效果。方法前瞻性选取2021年12月至2023年12月在攀枝花市妇幼保健院接受治疗的100例盆腔炎不孕症患者作为研究对象,按照随机数字表法将其分为观察组、对照组,每组各50例。观察组接受腹腔镜下盆腔粘连松解术及输卵管伞端造口术,对照组接受宫腔镜下输卵管插管通液术。比较两组患者的手术相关指标(术中出血量、手术时间、住院时间以及术后腹痛时间),术前和术后血清激素[雌二醇、黄体生成素(LH)、催乳素及促卵泡激素(FSH)]水平变化,术后并发症发生率以及随访1年后的自然受孕率和异位妊娠发生率。结果观察组患者的术中出血量为(120.50±15.30)mL,明显多于对照组[(85.20±10.70)mL],手术时间和住院时间分别为(60.68±6.54)min、(3.06±0.45)d,均明显长于对照组[(30.42±5.56)min、(1.85±0.52)d],差异均有统计学意义(P<0.05),但两组患者术后腹痛时间比较,差异无统计学意义(P>0.05)。术后,两组患者的雌二醇、催乳素均较术前升高,LH、FSH均较术前降低,差异均有统计学意义(P<0.05);观察组患者术后雌二醇水平为(56.54±6.12)pg/mL,明显高于对照组[(32.53±6.43)pg/mL],FSH水平为(5.91±2.31)IU/L,明显低于对照组[(7.88±2.11)IU/L],差异均有统计学意义(P<0.05),而两组患者术后LH和催乳素水平比较,差异均无统计学意义(P>0.05)。两组患者总不良反应发生率比较,差异无统计学意义(P>0.05)。随访1年,观察组患者的自然受孕率为82.00%,明显高于对照组(58.00%),异位妊娠发生率为4.00%,明显低于对照组(16.00%),差异均有统计学意义(P<0.05)。结论与传统宫腔镜下输卵管插管通液术相比,腹腔镜下盆腔粘连松解术联合输卵管伞端造口术能够显著提高因盆腔炎导致的不孕症患者的自然妊娠率,并有效降低异位妊娠的发生风险,具有良好的临床应用�Objective To investigate the clinical effects of pelvic adhesion-lysis and tubal fimbriostomy in the treatment of infertility caused by pelvic inflammatory disease.Methods A total of 100 infertility patients with pelvic inflammatory disease treated in Panzhihua Maternal and Child Health Hospital from December 2021 to December 2023 were prospectively selected as the research objects.According to the random number table method,they were divided into the observation group and the control group,with 50 cases in each group.The observation group received laparoscopic pelvic adhesion-release and tubal fimbriostomy,and the control group received hysteroscopic tubal catheterization.The operation related indexes(intraoperative blood loss,operation time,hospitalization time and postoperative abdominal pain time),the changes of serum hormones[estradiol,luteinizing hormone(LH),prolactin and follicle-stimulating hormone(FSH)]levels before and after operation,the incidence of postoperative complications,the natural conception rate and the incidence of ectopic pregnancy after 1 year of follow-up were compared between the two groups.Results The intraoperative blood loss of the observation group was(120.50±15.30)mL,which was significantly more than that of the control group[(85.20±10.70)mL],the operation time and hospitalization time were(60.68±6.54)min and(3.06±0.45)d,respectively,which were significantly longer than those of the control group[(30.42±5.56)min and(1.85±0.52)d],and the differences were statistically significant(P<0.05),but there was no statistically significant difference in postoperative abdominal pain time between the two groups(P>0.05).After operation,the levels of estradiol and prolactin in the two groups were higher than those before operation,and the levels of LH and FSH were lower than those before operation,the differences were statistically significant(P<0.05).The estradiol level after operation in the observation group was(56.54±6.12)pg/mL,which was significantly higher than that in the control gro

关 键 词：盆腔炎性疾病 腹腔镜 异位妊娠 不孕症 盆腔粘连松解术 输卵管伞端造口术 

分 类 号：R713.7[医药卫生—妇产科学]